Full Thickness, Near-Total to Total Lower Lip Reconstruction Using Superficial Circumflex Iliac Artery Perforator Free Flap: A Case Report.

Near-total to total lower lip defects present significant challenges for reconstructive surgeons, requiring restoration of oral competency, maximization of oral aperture, and cosmetic appearance. This report explores a novel reconstructive option addressing all three needs. Traditionally, local flap options restore cosmesis and oral competency by recruiting local tissue of similar thickness, pliability, and appearance, but often result in microstomia. Conversely, free flaps prevent microstomia but can lead to bulky and cosmetically unacceptable reconstructions. We present the first case of using a super-thin superficial circumflex iliac artery perforator (SCIP) free flap for near-total, full-thickness lower lip reconstruction. The patient was a 66-year-old female with recurrent squamous cell carcinoma of the lower lip, requiring wide local excision and resulting in an 80% full-thickness defect with unilateral oral commissure loss. An 8 cm × 5 cm × 5 mm SCIP flap was raised with a 4.5-cm pedicle length and anastomosed to the facial artery and vein. Clear fluids were commenced 7 days postoperatively, wounds healed 2 weeks postoperatively, and a normal diet was resumed at this time. The SCIP flap offers an excellent additional option for managing full-thickness near-total to total lower lip defects. Its thin, pliable nature and minimal donor site morbidity help restore oral competency, maximize oral aperture, and achieve a pleasing cosmetic result.

Reconstruction of Full-Thickness Lateral Defect of the Lower Lip and Vermilion with our Modification of a Fan Flap - Technique and Results.

Successfully restoring lateral lip defects, while ensuring proper mouth opening, oral competence, and the creation of an aesthetically pleasing vermilion, has consistently posed a challenging undertaking. In a prospective study conducted from 2006 to 2022, we employed our modified version of the McGregor fan flap technique to reconstruct post-oncosurgical pure lateral lower lip and complete lower lip defects. The study excluded cases involving a central lip defect or accompanying buccal mucosa involvement. A total of 126 flap procedures were performed on 122 patients, encompassing lower lip defects ranging from 30 to 100% in size. Unilateral flaps were performed on 118 patients, while four patients necessitated bilateral flap procedures. The reconstruction of the vermilion was accomplished using our modified flap technique in 114 patients, tongue flaps in two patients, and six patients, the flap's skin was folded to mimic the vermilion. Remarkably, no complications such as hematoma, necrosis, flap loss, infection, microstomia, or dribbling were encountered. The labial sulcus was found to be adequately formed. All patients achieved preoperative mouth opening within 3 months following surgery, with a mean oral sphincteric recovery time of 4.2 months. The color match of the reconstructed vermilion was excellent. Our modified fan flap technique stands as a dependable and robust choice for addressing moderate to large full-thickness lateral defects of the lower lip offering effective vermillion reconstruction in a single surgical procedure. The cases involving associated buccal mucosa or submucous fibrosis may necessitate alternative vermilion reconstruction approaches.

Reconstruction of extensive lower lip defects using vascularized mucosal flap with external skin complex tissue.

BACKGROUND: The complexity of lip anatomy and the roles played by the lip make the reconstruction of lip defects more challenging. Adequate reconstruction of lip defects requires adaptation of mucosa, vermilion, and skin features in lip as well as its specific function. METHODS: A 59-year-old male with left lower lip cancer underwent en-bloc resection and left selective neck dissection (SND), followed by immediate reconstruction using Facial Artery Myomucosal Island Flap (FAMMIF) with external Skin Complex Tissue. RESULTS: The use of chimeric flap based on FAMMIF and its external skin tissue allowed minimizing the postoperative problem of combination of both aesthetic and functional impairments. The FAMMIF is suitable for the reconstruction of lip mucosa and lip vermilion, while the external skin tissue can be use to replace the external lip skin defect. The patient was satisfied with the treatment outcomes. He is undergoing follow-up without any evidence of recurrence. CONCLUSION: FAMMIF with external skin complex tissue, as a reconstructive approach selected in our case of lip defect secondary to lip cancer resection, combined the reconstruction of both aesthetics and functions of the lower lip. The technique was found feasible and provided satisfactory postoperative outcomes.

Utilizing the Fujimori Gate Flap for the Reconstruction of Squamous Cell Carcinoma: A Case Report.

The surgical treatment of oral squamous cell carcinoma (SCC) results in tissue defects caused by the removal of the cancerous tissue. There are various reconstruction options available for lip construction. Harvesting the flap to reconstruct these defects undoubtedly results in substantial morbidity. Lip reconstruction can be performed more efficiently and with reduced side effects by utilizing flaps, which can minimize donor site morbidity and shorten surgical harvesting time. We are reporting a case involving a 52-year-old male with SCC of the lip who presented without any comorbidity. This case report describes the careful lip reconstruction using the Fujimori gate flap technique following complete surgical excision of the lesion.

Retrospective cohort study rethinking lip reconstruction: Versatility of the depressor anguli oris myocutaneous flap for large full-thickness defects.

BACKGROUND: Large full-thickness lip defects present a reconstructive challenge. OBJECTIVE: To describe the impact on clinical outcomes and institutional cost of the depressor anguli oris myocutaneous (DAOM) flap as an axial pattern transposition flap for reconstruction of large, full-thickness lip defects. METHODS: A multicenter retrospective cohort study of adults with large full-thickness lip defects who underwent DAOM flap reconstruction from 2011 to 2018 was conducted. DAOM flap anatomy and surgical technique were reviewed. The primary outcome of flap viability as well as additional clinical outcomes of postoperative complications and functional results were documented with follow-up ranging up to 11 years. Median length of stay and average institutional cost of care were analyzed. RESULTS: A total of 12 patients underwent DAOM flap reconstruction for large full-thickness lip defects. There was 100% flap survival with no episodes of reoperation or readmission. All patients reported maintenance of distinct oral commissures, wide oral opening and full gingivolabial sulcus, excellent oral competence, and intelligible speech. Mean case length was 144 ± 11.5 min with a mean length of stay of 1.6 ± 0.5 days and estimated mean institutional cost of $3766.67 ± $1167.06. CONCLUSIONS: The DAOM flap is an excellent reconstructive option for large full-thickness lip defects with strong functional results and limited donor site morbidity and institutional cost of care.

Myomucosal composite graft: A simple technique for full-thickness vermilion defects of the lower lip.

Reconstruction of vermillion defects of the lower lip requires careful consideration of functional and aesthetic aspects. Traditionally, various local flap methods involving tissue advancement from the corner of the mouth, lateral chin, and medial cheek have been commonly employed to fill lower lip defects. However, these approaches have inherent limitations, which include technical complexity, disruption of the orbicularis oris muscle, lip tightening, microstomia, and visible scarring. To overcome these limitations, we employed a free myomucosal composite graft from the lower lip to reconstruct small to medium vermilion defects. Our technique is based on a simple and reproducible surgical approach that facilitates natural volume rearrangement of tissues. Moreover, this method enables precise inset and tension-free repair, prevents lip tightening, and offers excellent aesthetic outcomes with no vertical scarring and appropriate color matching with surrounding tissues.

Design and fabrication of silicone cleft lip simulation model for personalized surgical training.

PURPOSE OF THE STUDY: To elucidate the design and fabrication methodologies employed in creating a personalized cleft lip simulation model, primarily intended for enhancing surgical training and diverse applications. The study further sought to assess the viability of integrating this simulation model into undergraduate oral experiments and instructional settings. STUDY DESIGN: Facial data from individuals with cleft lip conditions were acquired using a scanner. Subsequent stages involved reverse engineering and the utilization of 3D printing technology to generate a cleft lip silicone simulation model. The molding process entailed injecting silicone into a polylactic acid mold. The study enrolled 53 undergraduate students majoring in dentistry, who were randomly assigned to either a control or experimental group. A dedicated instructor guided each group independently, employing a combination of multiple-choice tests and surveys to gauge real-time evaluations and discern inter-group disparities. RESULTS AND CONCLUSIONS: We successfully designed and produced a personalized cleft lip simulation model, demonstrating notable efficacy in the context of cleft lip experimental teaching. Statistical analysis revealed a significant difference (P < 0.05) in the scores of the experimental group students on multiple-choice questions pertaining to cleft lip surgical procedures. Survey outcomes indicated that the experimental group students exhibited higher confidence levels in cleft lip surgery, as reflected from their responses to relevant questions, compared to the traditional group students. These differences were statistically significant (P < 0.05). The simulation model developed in this study emerges as a reliable and cost-effective training and teaching tool for cleft lip surgery.

The Evaluation of Upper Labial Swelling: An Arteriovenous Malformation.

Vascular malformations, which include disorders of the lymphatic or vascular systems, can appear in a variety of ways on radiographs, in the radiological department, and histologically. High-flow lesions with direct arteriovenous connections are known as arteriovenous malformations (AVMs). These lesions can cause soft tissue loss and deformity since they are difficult to diagnose early. This case report describes a 75-year-old female who presented with a severe bluish-purple swelling on her top lip. After conducting a thorough investigation, the patient's condition was quickly identified as AVM. After confirmation by USG Doppler and histological examination, the patient underwent a successful surgical resection that revealed a confined vascular lesion suggestive of AVM. The discussion explores the hemodynamic and embryologic factors that contribute to the formation of AVM, pointing out differences in hemodynamic properties and clinical symptoms. Treatment choices are influenced by the categorization of peripheral AVMs according to clinical standards and angiographic flow characteristics.

Squamous cell carcinoma of lip: Clinical feature analysis and suggestion of reconstruction algorithm.

Reconstruction of lips after squamous cell carcinoma (SCC) removal should restore functional and aesthetic roles; however, it remains a challenge. In this study we describe the clinical features of lip SCC and suggest a reconstruction algorithm. We retrospectively analyzed 34 patients with lip SCC who underwent reconstruction after Mohs micrographic surgery between January 2006 and March 2022. The mean age of the patients was 70.2 years. Seven tumors were on the upper lip and 27 tumors were on the lower lip. Twenty-five defects were located on the mucosal lip, eight defects involved both the mucosal and cutaneous lips, and one defect was confined to the cutaneous lip. Eighteen defects were smaller than 50% of the total lip size, and 16 were larger than 50%. Primary closure was mostly performed for defects smaller than 50% of the lip size (9/18 cases), and local flap, according to the location and size of the defects, was performed for larger defects. Thirteen patients experienced postoperative complications but improved within 1 year after surgery, except for one patient. We suggest a reconstruction algorithm with a 50% cut-off value. Defects smaller than 50% of the lip size could be reconstructed by primary closure. Even larger defects could be reconstructed by creation of a local flap from the remaining adjacent tissue with minimal postoperative complications.

Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients.

BACKGROUND: Lower lip reconstruction is crucial to restore oral integrity post-cancer excision. A perfect balance between form and function should be achieved. With an aging demographic, adapting surgical methods to meet the unique needs of the elderly becomes imperative. Our study aims to introduce a specialized algorithm for lower lip reconstruction; it was tailored to geriatric patients and emphasized the use of "simpler flaps". Additionally, "Pearls and Pitfalls" were provided for surgeons approaching lower lip reconstruction. METHODS: Between January 2018 and June 2021, a retrospective study was carried out. Data collection included patient demographics, defect attributes, reconstructive approaches, flap viability assessment, wound healing, and complications. The follow-up was carried out for a period of a minimum of 6 months. RESULTS: Among 78 patients, squamous cell carcinoma predominated with a mean defect area of 3308 cm2. Postoperative complications were recorded in two patients. All patients reported sensory restoration and overall satisfaction at the 6-month follow-up; secondary procedures were not necessary. CONCLUSION: Our reconstructive algorithm, focused on elderly patients, prioritizes less invasive reconstructive techniques and introduces innovative modifications to the established methods to achieve both aesthetic and functional outcomes with a low complication rate. In patients undergoing lower lip reconstruction, the subjective microstomia was found to be less relevant than the objective microstomia.