Bilateral mucosal rotation flap for repair of lower lip defect Noemı Eirıs, MD, Maria Jes us Suarez-Valladares, MD, Henry Alexander Cocunubo Blanco, MD, ngel Rodrıguez-Prieto, MD and Manuel A Le on, Spain
SURGICAL CHALLENGE An 80-year-old man presented with a noninfiltrating squamous cell carcinoma of the lower lip. After marking the affected area for excision, the resulting defect comprised about one-third of the lower lip up to the vermilion border without affecting the adjacent skin or the orbicularis oris muscle (Fig 1).
Fig 1. Nonsquamous cell carcinoma located on the lower lip. After marking the area for excision, the primary defect comprised about a third of the lower lip, and secondary incision was planned following the vermillion line.
SOLUTION Because the external border of the defect corresponded to the vermilion border and it was a superficial (ie, epithelial and subdermal) defect, primary incision was prolonged along the entirety of the vermilion border and the mucosal tissue was undermined on a subdermal plane. Closure of the defect was achieved with a bilateral rotation movement and a small dog-ear correction on the lip’s inner side, with an excellent result (Fig 2) at the immediate and late postoperative visits.
From the Department of Dermatology, Complejo Asistencial Universitario de Le on. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Noemı Eirıs, MD, Servicio de Dermatologıa, Complejo Asistencial Universitario de Le on, Altos de Nava s/n, 24071 Leon, Spain. E-mail: [email protected].
J Am Acad Dermatol 2015;72:e81-2. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.11.029
e81
e82 Eirıs et al
J AM ACAD DERMATOL
MARCH 2015
Fig 2. Bilateral mucosal rotation flap for lower lip defect. Immediate (A) and 8-week (B) postoperative appearance. The aesthetic and functional features of the lower lip have been preserved.
Mucosal advancement flaps are most often used for superficial reconstruction of the vermillion area. However, there are some disadvantages to advancing the entire mucosa, such as some degree of postoperative retraction or cosmetic distortion of the lip (because vermilion skin has different properties than oral mucosa). Our solution reduces the risk of scar contraction because the wound closure tension is distributed along the entire lip, even when flap movement is much greater on one side of the defect. This technique also allows for reduced bleeding, surgical and recovery time, and permits a better survival of the flaps because of their wide pedicle. Moreover, it offers an excellent aesthetic result; using only tissue from the vermilion preserves the homogeneity of the area.
SURGICAL CHALLENGE An 80-year-old man presented with a noninfiltrating squamous cell carcinoma of the lower lip. After marking the affected area for excision, the resulting defect comprised about one-third of the lower lip up to the vermilion border without affecting the adjacent skin or the orbicularis oris muscle (Fig 1).
Fig 1. Nonsquamous cell carcinoma located on the lower lip. After marking the area for excision, the primary defect comprised about a third of the lower lip, and secondary incision was planned following the vermillion line.
SOLUTION Because the external border of the defect corresponded to the vermilion border and it was a superficial (ie, epithelial and subdermal) defect, primary incision was prolonged along the entirety of the vermilion border and the mucosal tissue was undermined on a subdermal plane. Closure of the defect was achieved with a bilateral rotation movement and a small dog-ear correction on the lip’s inner side, with an excellent result (Fig 2) at the immediate and late postoperative visits.
From the Department of Dermatology, Complejo Asistencial Universitario de Le on. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Noemı Eirıs, MD, Servicio de Dermatologıa, Complejo Asistencial Universitario de Le on, Altos de Nava s/n, 24071 Leon, Spain. E-mail: [email protected].
J Am Acad Dermatol 2015;72:e81-2. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.11.029
e81
e82 Eirıs et al
J AM ACAD DERMATOL
MARCH 2015
Fig 2. Bilateral mucosal rotation flap for lower lip defect. Immediate (A) and 8-week (B) postoperative appearance. The aesthetic and functional features of the lower lip have been preserved.
Mucosal advancement flaps are most often used for superficial reconstruction of the vermillion area. However, there are some disadvantages to advancing the entire mucosa, such as some degree of postoperative retraction or cosmetic distortion of the lip (because vermilion skin has different properties than oral mucosa). Our solution reduces the risk of scar contraction because the wound closure tension is distributed along the entire lip, even when flap movement is much greater on one side of the defect. This technique also allows for reduced bleeding, surgical and recovery time, and permits a better survival of the flaps because of their wide pedicle. Moreover, it offers an excellent aesthetic result; using only tissue from the vermilion preserves the homogeneity of the area.
