Aesthetic and Functional Results of Flaps Reconstruction of Lips

Abstract

Introduction: The lips represent the main anatomical unit of the lower third of the face. Therefore, its surgical reconstruction represents a challenge for the surgeon, who seeks excellence in the restoration of facial functions, aesthetics and appearance. Many reconstruction techniques have been described, each with its advantages and disadvantages.

Objectives: To evaluate the aesthetic and functional results in all patients operated on for oncological lesions of the lips that required local, regional and free flaps.

Design: Retrospective observational.

Place of Application: Public hospital for tertiary care in tumors.

Material and Method: 19 patients, 11 women and 8 men, mean age 65 years (31-77). All patients with lip tumor pathology were included, with defects greater than 1/3 of the lip. There were 10 squamous carcinomas, 7 basal cell carcinomas, 1 venous hemangioma and 1 actinic keratosis. At resection, one patient required a marginal mandibulectomy and another a partial maxillectomy. Lymph node dissection was performed in 2 patients. As a reconstruction, a bilobed flap, 3 advancement flaps, 1 commissuroplasty with a rhomboid flap, 2 with Abbe-Esländer, 5 with Karapandzic, 2 with cheek, 1 Bernard-Burow and another with Fujimori, and 3 radial free flaps with long palmar were performed. All patients were evaluated in the immediate postoperative period, emphasizing the vitality of the flaps and healing, and functional and aesthetic results in the late postoperative period.

Results: All the flaps survived. 4 patients suffered surgical wound dehiscence. Regarding the functional results, complete oral continence was obtained in those defects, which could be reconstructed with flaps obtained from the residual lip. Major defects reconstructed with cheek or neighborhood flaps, or especially with a radial free flap with a palmar longus tendon, obtained very good results. Three patients suffered microstomia. Speech intelligibility was satisfactory in all. The esthetic results were rated as excellent, especially in the free flaps.

Conclusion: Satisfactory results, both functional and aesthetic, have been obtained in the reconstructions of large lip defects, with the radial microsurgical flap using the palmar longus tendon as a tension harness, achieving oral continence and adequate suspension. The choice of one or the other flap will depend on each patient, age, risk factors and the choice and experience of each surgeon.