Recent advances in lip reconstruction

Abstract

Purpose of review This article reviews recently described techniques used to reconstruct lip defects. Emphasis is placed on the ability of these flaps to restore function and appearance of the lips as well as their limitations. Recent findings The focus of recent advances in lip reconstruction has been to achieve better oral competence, speech and improved cosmetic appearance. New modifications to the traditional Karapandzic and Abbé flaps have expanded their uses. A host of novel local tissue transfer techniques has become available with improved outcomes and less morbidity. Similarly, new free tissue transfer methods have allowed for the creation of a more normal appearing lip with improved sensory and motor function. Although still experimental, tissue engineering of a mucocutaneous junction shows promise in its ability to recreate a normal vermillion. Summary Lip reconstruction techniques have continued to become more sophisticated in order to achieve better functional and cosmetic outcomes after resection. Several new local tissue and free tissue transfer techniques have recently been described and can be included in contemporary reconstruction algorithms.

The hybrid concept in lip reconstruction

“…Many microsurgical reconstructive procedures for the lip have been described and evolved, but they mostly produce a physical replacement with poor sensation, poor mobility and aesthetically poor mismatch to local tissues. 3,4 It is fortunate however the older patients with poor skin elasticity are the ones who usually undergo lip resection. It needs to clarified that percentage of lip defects following resection is estimated as per the inter commissure distance for a particular patient, since it varies from one individual to another.…”

Upper lip reconstruction post major cancer resections using the hybrid concept

“…6 In major lip defects, many free tissue transfer techniques including radial forearm flap with palmaris longus, have been described and evolved, and are considered as viable options for some surgeons. [3][4][5] But these carry the disadvantages of being barely a physical barrier with poor sensation, texture mismatch and the inability to replace a vermilion like tissue. 5 We have already introduced the "hybrid concept" of reconstruction in lower lip major defects, by rearranging the surrounding and regional soft tissues, using various concepts of flaps.…”

“…[3][4][5] But these carry the disadvantages of being barely a physical barrier with poor sensation, texture mismatch and the inability to replace a vermilion like tissue. 5 We have already introduced the "hybrid concept" of reconstruction in lower lip major defects, by rearranging the surrounding and regional soft tissues, using various concepts of flaps. 6 Uglesic et al, Gonzalez et al have also shared their experience of the lower lip large defects being reconstructed with different flaps.…”

Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option

“…The lower lip performs various functions, such as ensuring proper mouth closure during swallowing, oral competence for saliva containment, speech, facial mimicry and aesthetic harmony 1 . Squamous cell carcinoma is the most common malignancy of the lower lip 2 .…”

“…There are many reconstructive options after excision of tumours of the lower lip, and their use depends on the size, location and type of defect. Smaller lesions (less than one third of the lip) can be resolved with direct closure after wedge excision 5 , while larger defects (affecting the entire lip, including the vermilion) can be reconstructed using a free flap 1 . Medium- and large-sized defects, involving between one-third and the entire lower lip, can be repaired with pedicled local flaps, such as the Abbe flap 6 , the Karapandzic flap 7 , the flap designed by Yu 8 , or the gate flap described by Fujimori 9 .…”