Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients.

Abstract

Background: Nonmelanoma skin cancer (NMSC) of the perioral region is not uncommon. Basal cell carcinoma is predominant in the upper lip area and squamous cell carcinoma in the lower lip area. While smaller lesions can be treated by excision followed by primary closure larger defects after tumor surgery can be challenging.Objectives: Analysis of outcome after complete surgical excision with micrographical control of excision margins (delayed Mohs surgery) of large NMSC's of the perioral region (lips and chin). Patients and methods:This is a retrospective, single-center analysis of patients with defects after delayed Mohs surgery of ≥ 3 cm of the perioral region. The study included a total of 25 patients (4 women and 21 men) with a mean age of 83.7 years. Twenty patients were diagnosed with squamous cell carcinoma and five had basal cell carcinoma. The lower lip was affected in 19 patients, the upper lip in 4 patients and the chin in 2 patients. Tumor stage was either T1N0M0 or T2N0M0. The most common procedure for lower lip defect closure was staircase or modified staircase technique. Cheek advancement flaps were used for upper lip defect closure. Inferiorly based nasolabial rotational flap, cheek rotational flap and modified Webster flap were also employed. In one patient Webster flap and unilateral staircase technique were combined. Results:In all patients the tumor was removed completely with preservation of function and aesthetics. No local recurrence was observed after a median follow-up of 4.9 years. Conclusion:Perioral reconstruction after removal of large NMSC is a complex issue. The age group of over 70 years, frequently with comorbidities, requires a robust surgical technique with short operation times and tailored approaches for defect closure. (J Dermatol Case Rep.

V-shaped Folded Nasolabial Flap in the Repair of the Anterior Buccal Mucosal Defect

“…Nasolabial flap is also one of the commonly used adjacent tissue flaps for buccal mucosal defect repair. The buccal artery is the main blood supply artery for the nasolabial flap, 10 which arches over the lower edge of the mandible at the front edge of the masseter muscle attachment to the face, and ascends in a tortuous way through the deep face of the laughing muscle, the superficial face of the buccal muscle, and 1-1.5 cm beside the corner of the mouth, sends out the superior and inferior labial arteries near the corner of the mouth and continues to ascend along the lateral side of the nose. In addition to the buccal artery, the upper part of the nasolabial fold has the communication between the ophthalmic artery and the medial canthal artery , suborbital artery branches and anastomotic branches.…”

“…The classic nasolabial flap is also one of the traditional adjacent tissue flaps for the repair of buccal mucosal defects. 10 However, according to its anatomical basis, the inferior pedicle must retain a wider pedicle in order to maintain blood supply in the inferior pedicle flap, and the terminal segment of the superior pedicle flap needs to retain a certain thickness of subcutaneous tissues for protection. The superior and inferior pedicles need to reverse 180°to place the skin side on the mouth and the buccal mucosa.…”

“…According to the characteristics of nasolabial flap blood supply, the pedicle of the classic nasolabial flap can be designed as the inferior type (blood supplied by the buccal artery) or the superior type (blood supplied by the medial canthal artery or the infraorbital artery). The classic nasolabial flap is also one of the traditional adjacent tissue flaps for the repair of buccal mucosal defects 10. However, according to its anatomical basis, the inferior pedicle must retain a wider pedicle in order to maintain blood supply in the inferior pedicle flap, and the terminal segment of the superior pedicle flap needs to retain a certain thickness of subcutaneous tissues for protection.…”

Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada)

“…Lower lip defects after cancer removal are a challenge for reconstruction. A loss of labial continence increases the risk of dysphagia and sialorrhea, with negative effects on esthetics, function and health-related quality of life [ 10 ][ 11 ][ 12 ].…”

“…Various techniques have been developed over time to improve functionality and esthetics [ 8 ][ 9 ][ 10 ][ 11 ][ 12 ][ 13 ][ 14 ][ 15 ][ 16 ][ 17 ]. Although multiple-step procedures such as the Abbé - Estlander flap can yield good results [ 13 ], single step procedures are favoured by patients.…”