Lower lip reconstruction strategies - SciELO

1 Rev Bras Cir Pl st. 2012;27(4):536-41536 Siqueira EJ et lip reconstruction strategiesEstrat gias em reconstru o do l bio inferiorABSTRACTB ackground: The upper and Lower lips represent the most important functional and aesthetic anatomical structures of the Lower segment of the face. Given the complex functions of these structures, reconstruction of labial defects presents a challenge for plastic surgeons. Methods: Thirty patients with full-thickness Lower lip defects un-derwent lip reconstruction according to the extent of the defect after tumor resection.

2 Results: Six (20%) patients presented lesions of up to 30% of the total lip surface that required primary closure. Eighteen (60%) patients had lesions of 30-80% of the total area of the Lower lip that were repaired using a myomucosal flap; in 14 of these patients, bilateral skin flaps were also used due to cutaneous involvement associated with the resection. Five ( ) patients had lesions on the Lower lip that were adjacent to the oral commissure; therefore, they underwent reconstruction using an Abb -Estlander flap with a myomucosal flap and bilateral skin flaps.

3 One ( ) patient had a lesion covering 90% of the Lower lip that was reconstructed using the Webster-Bernard tech-nique and a tongue flap. Conclusions: Here, we present a simplified, systematic, and literature-based strategy for planning Lower lip reconstructions that employs effective and reproducible techniques, which can be used for training resident physicians in the treatment of complex Lower lip lesions according to the extent of tissue loss, thereby yielding appropriate aesthetic and functional : Lip/surgery. Surgical flaps.

4 Reconstructive surgical procedures. RESUMOI ntrodu o: Os l bios superiores e inferiores representam as estruturas anat micas funcio-nais e est ticas mais importantes do segmento inferior da face. Al m disso, possuem fun- es complexas, sendo a reconstru o de defeitos labiais um desafio ao cirurgi o pl stico. M todo: Trinta pacientes apresentando defeitos de espessura total do l bio inferior foram submetidos a reconstru o do l bio baseada na extens o dos defeitos ap s ex rese tumoral. Resultados: Seis (20%) pacientes apresentavam les es de at 30% da superf cie total do l bio, sendo realizado fechamento prim rio.

5 Dezoito (60%) pacientes apresentavam les es de 30% a 80% da superf cie total do l bio inferior, sendo realizado retalho miomucoso de vermelh o; em 14 desses pacientes, em decorr ncia da perda cut nea associada ressec- o, foi associado retalho cut neo mentolabial. Cinco (16,6%) pacientes tinham les es no l bio inferior e comissura oral adjacente, sendo submetidos a reconstru o pela t cnica This study was performed at Hospital S o Lucas da Pontif cia Universidade Cat lica do Rio Grande do Sul (St. Luke s Hospital, Catholic University of Rio Grande do Sul), Porto Alegre, RS, to SGP (Sistema de Gest o de Publica es/Manager Publications System) of RBCP (Revista Brasileira de Cirurgia Pl stica/Brazilian Journal of Plastic Surgery).

6 Article received: June 24, 2012 Article accepted: October 23, 2012 Evandro Jos siquEira1 Gustavo stEff En alvarEz2 francisco fElipE laitano3 pEdro dJacir Escobar Martins4 Milton paulo dE olivEira5 Franco T et FS et ARTICLE1. Plastic surgeon, specialist member of the Sociedade Brasileira de Cirurgia Pl stica (Brazilian Society of Plastic Surgery - SBCP), Porto Alegre, RS, Brazil, Porto Alegre, RS, Brazil. 2. Plastic surgeon, specialist member of SBCP, Doctoral student in Medicine and Health Sciences at Pontif cia Universidade Cat lica do Rio Grande do Sul (Catholic University of Rio Grande do Sul - PUCRS), Porto Alegre, RS, Resident surgeon in Plastic Surgery at Hospital S o Lucas da Pontif cia Universidade Cat lica do Rio Grande do Sul (St.)

7 Luke s Hospital, Catholic University of Rio Grande do Sul), Porto Alegre, RS, Brazil4. PhD, full member of the SBCP, Head of the Department of Plastic Surgery, Hospital S o Lucas da Pontif cia Universidade Cat lica do Rio Grande do Sul (St. Luke s Hospital, Catholic University of Rio Grande do Sul - PUCRS), Porto Alegre, RS, Master, full member of the SBCP, preceptor of the Plastic Surgery Service of the Hospital S o Lucas da Pontif cia Universidade Cat lica do Rio Grande do Sul (St. Luke s Hospital, Catholic University of Rio Grande do Sul - PUCRS), Doctoral student in Medicine at Universidade Federal de Ci ncias da Sa de de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, RS, Bras Cir Pl st.

8 2012;27(4):536-41537 Lower lip reconstruction strategiesINTRODUCTIONThe upper and Lower lips are the most important func-tional and aesthetic anatomical structures of the Lower seg -ment of the face. The lips contribute to chewing, speech, facial expressions, and oral competence. Due to these com -plex functions, the reconstruction of lip defects can pose a challenge to plastic surgeons that seek to achieve excel-lence in aesthetic and functional lip restoration. Infections, traumatic injuries, congenital abnormalities, and tumors (including squamous cell carcinoma) most often cause de -fects in the Lower lip1.

9 Surgical trauma resulting from lip resections can result in significant changes in lip appea-rance and normal function, which deeply impact patient self-image and quality of changes in the appearance of the vermilion border, oral commissure, or cupid s bow are easily detected by the casual observer. The loss of lip competence can interfere with articulation, whistling, kissing, and the containment of salivary secretions. Thus, the functional and aesthetic reconstruction of the lip has been described for centuries2.

10 reconstruction can be very effective for small defects. Ho -wever, the larger the defect, the more difficult it is to create an aesthetically pleasing and functional the present study, we describe a strategy for Lower lip reconstruction based on the size and location of defects, which primarily occur following resection of tumor lesions, that involves the use of treatments ranging from primary closure to local flaps of the remaining structures. This study was performed at the Department of Plastic Surgery, St.