Lip reconstruction: Larger wounds may require two-stage transposition procedure -

Lip reconstruction: Larger wounds may require two-stage transposition procedure - - DermatologyTimes

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Lip reconstruction: Larger wounds may require two-stage transposition procedure

Nov 1, 2009
By: Rochelle Nataloni
Dermatology Times

Island pedicle flaps and advancement flaps are mainstay of lip reconstructive surgery
Some wounds will still need something more inventive

A large wound of the upper lip to be repaired with a cheek advancement flap.(Photos: Glenn D. Goldman, M.D).

Burlington, Vt. — Most operative wounds of the upper lip can be repaired linearly, with an island pedicle flap, or with an advancement flap, but about 10 percent of wounds will need something more inventive.

"When someone has a fairly substantial wound from a skin cancer, island pedicle flaps and advancement flaps are the 'workhorse' procedures that we rely on in the vast majority of cases," says Glenn D. Goldman, M.D., associate professor and chief of dermatology, the University of Vermont College of Medicine, Burlington, Vt.

The flap is elevated out onto the cheek to allow for recruitment of laxity and displacement of dog ears.

"There are times, however, when we employ more nuanced repairs that enable us to maintain the nasolabial fold or hide the incision by making the primary arc of a repair run the nasolabial fold," Dr. Goldman says.

Linear repairs

Linear repairs and lip wedge reconstructions offer highly aesthetic outcomes, according to Dr. Goldman, who says these techniques produce an almost invisible line on the lip.

The vermilion has been advanced outward.

For many wounds, a straightforward vertical linear repair will be appropriate. "The only problem is that if the wound is too large, then it is possible that a linear repair can distort the philtrum or make the mouth too small, which is why advancement flaps are often used," Dr. Goldman says.

He says physicians should not be afraid to extend linear repairs right through the vermilion border — something that was avoided historically.