Since 1990, we have performed 18 lip reconstructions with 22 flaps in addition to the small local flaps used in cases such as cleft lip and macrostomia. Gordon Buck, during the Civil War, was the first surgeon in the English-speaking world to describe a cross-lip reconstruction.24 Despite these reports 64) Bakamjian, V.: Anteriorly and posteriorly based flaps … The flaps were then advanced medially, intercalating the points and troughs of the incision line appropriately. Bektas G, Cinpolat A For upper lip defects requiring bilateral flap reconstruction, the incision extends from the nasal base, along the melolabial crease to the labiomandibular crease (). Facial Plast Surg Clin North Am. Karapandzic M. Reconstruction of lip defects by local arterial flaps. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap. Deeper facial defects often require a wide variety of flap techniques to optimize closure. Lip Reconstruction • Lips provide important aesthetic (ie. John M Le, Sherry S Collawn, Revisiting the value of the ‘bandoneon’ flap for lower lip reconstruction: a report of two cases and outcome, Journal of Surgical Case Reports, Volume 2020, Issue 5, May 2020, rjaa082, https://doi.org/10.1093/jscr/rjaa082. In this article, we aim to reintroduce the use and value of the stretched mucomyocutaneous ‘bandoneon’ flap that was previously described by Peled et al. Department of Oral and Maxillofacial Surgery. Total lip reconstruction requires not only free flaps and/or distant pedicle flaps but also local flaps such as Bernard–von Burrow–Webster flaps, Gillies fan flaps, Fujimori gate flaps and modified von Brun flaps []. Br J Plast Surg. Squamous cell carcinoma of the lower lip affecting central lip. 3). Lip reconstruction may be required after trauma or surgical excision. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, Suicidal acid ingestion leading to gastric outlet obstruction treated by early definitive surgery—case report, Delayed presentation of a rare and complex multi-vessel pulmonary arteriovenous fistula following penetrating chest-wall trauma, Temporal lobe meningioma concurrent with multiple intracranial aneurysms, Intrapulmonary solitary fibrous tumour: a case report, Volume 2021, Issue 2, February 2021 (In Progress), http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-what-is-basal-and-squamous-cell, https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf, https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf, http://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic, Perianal basal cell carcinoma: a common cancer in an uncommon location, Neglected skin cancer in the elderly: a case of basosquamous cell carcinoma of the right shoulder, Refining aesthetic approaches to tuberous breast using combined minimally invasive approaches to treat moderate asymmetric tuberous breast, Unusual presentation of rectal squamous cell carcinoma perforation—case report and literature review. 5). Karapandzic M. Reconstruction of lip defects by local arterial flaps. A three-layered closure was used in similar fashion as previously described with vicryl sutures for the muscular layer, chromic gut for mucosal layer and nylon suture for the skin (Fig 9). Their role in aesthetic balance, facial expression, speech, and deglutination is not replicated by Similar to the first case, bilateral mucomyocutaneous flaps were raised in addition to a buccal rotational flap for the advancement of the vermilion at the left lateral commissure. When focusing specifically on lip cancers, basal cell carcinoma has been shown to be more prevalent on the upper lip and squamous cell carcinoma on the lower lip, both of which are commonly exposed to UV radiation. 63) Franca, J. G.: Lip reconstruction using a lingual graft. Fortunately, with early detection and treatment, surgery is the curative treatment for basal and squamous cell carcinoma. Reconstruction of a Large Upper Lip Defect with Severe Associated Injuries by the Combination of the Kazanjian and Abbé Flaps Janos Varga 1 , Sandor Pinter 2 , Mark Antal 3 , Akos Varga 4 , Lajos Kemeny 5 , Katalin Nagy 6 and Gabor Braunitzer 7 * http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-what-is-basal-and-squamous-cell , (9 February 2020 date last accessed). Conundrum Keys In this case, the lip reconstruction involved reconstruction of both the cutaneous and mucosal layers of the lip. In the reconstruction of the lips, it is necessary to consider not only the repair of tissues, but also the cosmetic appearance and the function.Since 1990, we have performed 18 lip reconstructions with 22 flaps in addition to the small local flaps used in cases such as cleft lip and macrostomia. Lip reconstruction 1. The flaps are then stretched medially to cover the defect with the points of the zigzag approximated appropriately. Whether performed in a single or delayed stage, this technique has demonstrated good esthetic outcome with minimal scarring, preservation of lip competence and sensory function and minimal microstomia. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. Lip reconstruction after tumor resection can be challenging due to the size of the full-thickness defect and its effect on local tissue anatomy, esthetics and function. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of “like Ishii LE, Byrne PJ. In this article, we reintroduce the use and value of the bilateral mucomyocutaneous ‘bandoneon’ flaps for lower lip reconstruction in two of our patients. Background Radial free forearm flaps is indicated patients with total or near-total defects in their lower lip. Section of Plastic and Reconstructive Surgery Department of Otorhinolaryngology, Nagoya City University, Medical School, Department of Otorhinolaryngology, Nagoya City University. 1 The Burow method represents the most common Lip reconstruction Oral Maxillofac Surg Clin North Am. In the reconstruction of the lips, it is necessary to consider not only the repair of tissues, but also the cosmetic appearance and the function. Lip reconstruction poses a particular challenge to the plastic surgeon in that the lips are the dynamic center of the lower third of the face. The lips are necessary for speech, facial expression, and eating. 4). In this article, we reintroduce the use and value of the bilateral mucomyocutaneous ‘bandoneon’ flaps for lower lip reconstruction in two of our patients. Often with lip defects of one- to two-thirds out of the total lip length, the use of local advancement flaps results with better esthetic outcome due to the utilization of the remaining lip structure. When compared with other techniques, this technique offers a good esthetic outcome with minimal scarring, preservation of lip competence and sensory function and minimal microstomia. At the 14-month follow-up appointment, the patient continues to report no problems with speech, oral function or microstomia (Fig. Closure was then achieved in a sequential three-layered fashion starting with the orbicularis oris muscle fibers, mucosa, and skin, respectively. The patient was very pleased with the esthetic outcome (Fig. Copyright © 2021 Oxford University Press and JSCR Publishing Ltd. In 1898, Abbe first described the lip switch flap (Abbe flap), which was originally designated as a complete philtral reconstruction for the relief of the bilateral cleft lip deformity. In some cases, reconstruction is difficult using a simple local flap such as an advancement flap, but the buccal mucosal graft is a good choice for mucosal lip reconstruction. A back-cut incision was performed in the mucosa on the flap raised on the left in order to advance the buccal mucosa anteriorly (Fig. Disclaimer: This channel is intended as an Encyclopedia for Medical Practitioners. 40 Potential complications of total lip reconstruction include Pages 279-285, (compatible with EndNote, Reference Manager, ProCite, RefWorks). The patient did not report any difficulty with speech, eating or microstomia. 1974; 27:93–97. The patient underwent a revision surgical procedure with a V-Y advancement for the remaining cutaneous ‘notch’ of the functional lower lip, Z-plasty for scar contracture of inner buccal lower lip and abdominal fat grafting to the lower lip. Lip cancer. The use of this flap has been liberalized, and today it is quite useful and a versatile means of … Artificial intelligence diagnostic system predicts multiple Lugol-voiding lesions in the esophagus and patients at high risk for esophageal squamous cell carcinoma. Even with the many techniques described in the literature, reconstructive surgeons continue to revise, modify and develop new techniques to improve esthetic and functional outcome. Medical School, Department of Head and Neck Surgery, Aichi Cancer Center, 1995 7). Then a dermal repair scaffolding (Integra® PriMatrix®, Integra LifeSciences, Plansboro, NJ, USA) was used for space maintenance and tissue bed preparation (Fig. Summary: Reconstruction of substantial-sized upper lip defects may require an Abbe flap reconstruction to avoid excessive tightness and deformity. tral lip flaps for reconstruction of a lower lip defect 10 years following Sabattini. Clipping is a handy way to collect important slides you want to go back 6). As a result, this often leaves a considerable sized defect that can be challenging to close primarily without distorting the local soft tissue anatomy and potentially creating a limited mouth opening (microstomia). Flap design (a) incision marked (b) specimen excised, flap medially advanced (c) closure. On the other hand, other techniques may result in larger scars, denervated flaps and significant microstomia. The first patient underwent both surgical excision followed by reconstruction in one stage, whereas the second patient first underwent surgery and reconstruction in two stages due to the defect size. The local and regional flaps do not usually provide an adequate amount of support, coverage, or lining for large defected areas, even Using the zigzag or ‘running W’ incision design in the labiomental fold, bilateral mucomyocutaneous ‘bandoneon’ flaps were raised based off of the inferior labial arteries (Fig. Furthermore, almost 90% of lip cancers occur in the lower lip with squamous cell carcinoma being the most common histologic variant, followed by basal cell carcinoma [4]. A wide local excision of the tumor with 5–10 mm circumferentially is the standard procedure performed [5–7]. Approximately 90% of non-melanoma skin cancers occur due to prolonged exposure to ultraviolet (UV) radiation from the sun [3]. Rev Ass Med Bras 17: 123 1971. The use of local flaps in lip reconstruction often follows oncologic resection of common skin malignancies including basal cell carcinoma and squamous cell carcinoma. Make sure that this line does not go beyond the labiomental junction. 8). A 48-year-old male presented with an invasive squamous cell carcinoma involving two-thirds of the lower lip (Fig. Two white male patients presented with squamous cell carcinoma of the lower lip that were surgically excised and the defect reconstructed using bilateral ‘bandoneon’ advancement flaps. Lip Reconstruction Critical in speech, sustenance, and conveyance of emotions, functional integrity of the lips requires preservation of oral aperture and competence as well as sensation and mobility. Total lip defects and defects larger than 80% of lip length would be candidates for reconstruction via larger composite flaps, cheek flaps, or possible free-tissue transfer flaps. The flaps are then sutured in a three-layered fashion: mucosa, muscle and skin (Fig. In: Strauch B, Vasconez LO, Hall-Findlay EJ, Lee BT (eds). After resection of the tumor with clear margins confirmed with frozen section analysis, ensure that there is adequate hemostasis on the tissue bed of the defect area. Goals of the reconstruction procedure are to restore patients oral competence, speech, and diet as well as to permit oral hygiene and as normal as possible appearance [ 6 – 8 ]. A wide local excision with negative margins was performed and resulted in a 5- × 3-cm defect. iTRAQ-based analysis for the identification of MARCH8 targets in human esophageal squamous cell carcinoma. 1 Although the Gillies fan flap has been largely replaced by the Karapandzic flap, it can still be useful in select situations and is important to discuss for historical reasons. Vicryl sutures were used for the muscle layer, chromic gut sutures for mucosa and nylon sutures for the skin. Most importantly, the wet line and vermilion border must be realigned properly. 1). At the 1-week follow-up appointment, final pathological permanent sections verified negative margins, and the patient was scheduled for the second stage of the surgery. A novel diphtheria toxin-based bivalent human EGF fusion toxin for treatment of head and neck squamous cell carcinoma. A brief discussion of the more widely used tissue transfer techniques precedes discussion of the approach and philosophy to closure based on location. "Alternative is Karapandzic flap ifthe cross-lip flaps … Estlander-Abbe flaps, nasolabial flaps, and fan flaps are still useful, but we must distant flaps for patients with large defects after resection of a malignant tumor and for those who have had full-dose irradiation. In the first stage, a wide local excision was carried out with negative margins observed via frozen sections (Fig. Rev Ass Med Bras 17: 123 1971. Carlson ER, Kelley JR, Subramanian J. Peled IJ, Taran A, Barak A, Ullmann Y. Peled IJ, Ullman Y. Bandoneon technique: mucomyocutaneous stretched flaps in lip reconstruction. Lip defects resulting from trauma or ablative surgery can pose a challenging task for a reconstructive surgeon. All in all, based on the size and location of the defect, lip reconstruction can be performed using a variety of surgical techniques, each with their own benefits and drawbacks. The lips are considered the beginning of the oral cavity and are the most common site of oral cancer. Lower lip defect after surgical excision with zigzag flap design drawn. We hope that by reintroducing the ‘bandoneon’ flap, reconstructive surgeons will remember to keep this technique in their armamentarium for the future. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. For lower lip reconstruction with bilateral Karapandzic flaps, the3). HDAC1 regulates the chemosensitivity of laryngeal carcinoma cells via modulation of interleukin-8 expression. The use of free revascularized osteo-cutaneous flaps (e.g., fibula or iliac crest flaps) permits reconstruction of large composite defects of the lip and mandible. In: National Comprehensive Cancer Network (NCCN). At the inferior portion of the defect site, extend a horizontal line in a zigzag design bilaterally from the wound edges. Lower lip defect after surgical excision. Volume 7 One of these had postoperative bleeding from a cavernous hemangioma, the other had had full-dose irradiation.In lip reconstruction, we must reconstruct both, mucosa and skin, choosing local facial donor sites which match both color and texture. When compared with other flap designs, it can be used as a single-stage procedure with a very good esthetic outcome, minimal to no microstomia and preservation of lip competence and sensory function. Lip reconstruction. Issue 3 Squamous cell carcinoma of the lower lip affecting the midline to left commissure. 14 months following bilateral flap surgery. [] [Google Scholar] Civelek B, Celebioglu S, Unlu E, Civelek S, Inal I, Velidedeoglu H V. Denervated or innervated flaps for the Br J Plast Surg. Novel Flaps for Lip Reconstruction By STL Volume 11 Number 6 - August 1, 2006 904 A. J. Kaufman, MD 1 and T. E. Rohrer, MD 2 1. LIP RECONSTRUCTION Dr. Sumer Yadav Mch – Plastic and reconstructive surgery sumeryadav2004@gmail.com You just clipped your first slide! Cases who employed combined techniques for red lip reconstruction are represented with two colors in the stacked bar graph. At three-month follow-up, the surgical site was well healed with notable thinning of vermillion border of the lower lip and a small scar contracture of the inner buccal mucosa. In 5 of these patients, we also constructed semi-dynamic tensor fascia lata supports for the lower face.The flaps took successfully in 16 patients, but in 2 there was partial necrosis. © The Author(s) 2020. In addition to the commonly performed local flaps that have been described in the literature for defect sizes of one- to two-thirds of the total lip length, we reintroduce the use and value of the bilateral mucomyocutaneous ‘bandoneon’ flap for lower lip reconstruction. Case Example Lip Reconstruction Peri-alar Crescentic Advancement Flap S/P "Moat" Procedure for lentigo maligna surrounding invasive melanoma Moat Procedure: refers to circumferential clearance of margins by Mohs procedure to ensure adequate peripheral margins - like a "moat around castle" (see references below re: margins for melanoma in situ and 'square' procedure). Cutaneous lip rotation flaps are most frequently employed to repair defects involving the more lateral portion of lip skin (see Fig. Total or near total lower lip reconstruction remains a challenge to the reconstructive surgeon. 2014 Aug;26(3):335-57. doi: 10.1016/j.coms.2014.05.013. 2). Lip reconstruction is most commonly used in oncology cases. 2009 Aug. 17(3):445-53. . 19-14). vascular free flaps, to achieve reconstruction for defects of the lip, as well as for midface defects. Skin cancer is the most common malignancy occurring in the USA and worldwide. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. In 10 patients the reconstruction followed resection of a malignant tumor, in 3 it was for repair after removal of a benign tumor and in 5 it was to repair scarring. When considering the types of flaps to use for lip defects of one- to two-third total length, a variety of flaps designs have been described, each with its benefits in drawbacks. Oxford University Press is a department of the University of Oxford. A 75-year-old male presented with a moderately differentiated invasive squamous cell carcinoma affecting one-third of the lower lip length (Fig. However, a thin cutaneous upper lip defect may require a different approach. 10). Complete lower lip reconstruction with in-folded extended pedicled deltopectoral flap: Case report and review of the literature Olayinka A Olawoye 1, Oluwabunmi M Fatungase 2 1 Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria 2 Department of Anaesthesia, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria Achieving these targets is very difficult especially in total lower lip defects. At the 18-month follow-up appointment, physical examination revealed a well-healed and camouflaged scar, no microstomia, preserved lip sensation and lower lip competence. Correspondence address: Tel: 562-290-7761; Fax: 205.975.6671; E-mail: Search for other works by this author on: Prevention and early detection strategies for melanoma and skin cancer: current status, Oral, Head and Neck Oncology and Reconstructive Surgery, Management of nonmelanoma skin cancer in 2007, National Comprehensive Cancer Network (NCCN), Clinical Practice Guidelines in Oncology: Squamous Cell Skin Cancer, Clinical Practice Guidelines in Oncology: Basal Cell Skin Cancer, Lip reconstruction using stretched mucomyocutaneous flaps, Aesthetics and function in lip reconstruction, Grabb’s Encyclopedia of Flaps Head and Neck. Shades of blue represent myomucosal lip island flaps and yellow represent other flaps… Lip Anatomy and Reconstruction 2. Lower lip defect prior to advancement of “bandoneon” flaps. A full-thickness incision is then completed through the skin, muscle and oral mucosa with careful attention for the inferior labial arteries laterally as the flaps are raised. We used Estlander-Abbe flaps in 6 patients, latissimus dorsi M. C. flaps in 4, rotation flaps in 4, nasolabial flaps in 4, fan flaps in 2, and cheek mucosal flaps in 2. More over it is very important to prevent leakage of saliva and food by adequate supports for the angles of the mouth. Mick Jagger) and functional role (both sphincteric and fine motor movements) • The vermilion is highly sensitive to temperature, touch and pain • Aims of reconstruction are to restore function, maintain sensation and avoid cosmetic deformity for lower lip reconstruction [8–10]. Many surgical techniques have been described and utilized based on size and location of the lip defect [1]. RECONSTRUCTION OF LIP DEFECTS: ONE HALF OF LOWER LIP FIGURE ]., Decision tree for management of lower lip defects. Mild- to moderate-sized lip defects that affect one- to two-thirds of the total lip length often require that utilization of local soft tissue rearrangement in order to re-establish lip anatomy, function and esthetics. Introduction The first published descriptions of lip reconstruction can be found in the ancient Sanskrit texts of the Susruta Samhita, published around 1000 BC. Any reconstruction of the lips must include both functional and cosmetic considerations. lower lip reconstruction with gracilis free flap harvested without the overlying skin paddle, and most of them used a combination with other free flaps for big facial injuries, but important donor-site morbidity was observed. When compared with other flap designs, it can be used as a single-stage In the period 1967 to 1972, reconstruction of lip defects by arterial flaps was carried out on 58 patients. Analysis of Lip Reconstructions with Flaps, Edited and published by : Japan Society of Stomato-pharyngology, https://doi.org/10.14821/stomatopharyngology1989.7.279. At the time of reconstruction, the size of the defect was 2.5 × 10.5 cm after removal of the dermal scaffold. Both received wide local excisions with negative margins prior to reconstruction. 1974 Jan. 27(1):93-7. . Tumor resection and reconstruction was planned in two stages due to the initial size of the tumor. In contrast, advancement flaps are most commonly used to repair centrally located cutaneous defects. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. This report presents a technique using super‐thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. In particular, the leading two types of skin cancers are basal cell carcinoma and squamous cell carcinoma [2].