Lip Reconstruction Flashcards
What are your options for reconstruction of a vermillion defect
- V-Y mucosa advancement - V-Y vermilion advancement - vermillion switch - bipedicled mucosa advancement tongue flap - FAMM flap - Goldstein vermillion musculocutaneous flap
How do you classify lower lip defect
by subunit involved by size by component by thickness
What are your options for reconstruction of a lower lip defect
1’ closure with wedge and barrel/burrow triangle
What are your options for reconstruction of lower lip defect up to 1/2
- step ladder advancement - reverse Abbe - Estlander - unilateral Gilles Fan flap - Karapandzic flap - DAO flap
What are your options for reconstruction of a lower lip 2/3 to total defect?
- bilateral Gilles Fan flap - Webster Bernanrd burrow - Fujimori Gate flap (inferior NL flaps) - regional/free
How do you classify upper lip defects?
by subunit by size
What are your options for reconstruction of a lateral lip defect
- 1’ closure - perialar crescentric advancement flap - nasolabial flap - A to T closure - Abbe - Reverse Estlander
What are your options for reconstruction of a philtral defect?
- 1’ closure - STSG - Abbe
What are your options for reconstruction of a philtral and lateral defect
- bilateral perialar crescentric flap +/- Abbe - Reverse Karapandzic
What are your options for reconstruction of a philtral and lateral defect >2/3
- bilateral nasolabial fold +/- Abbe - upper lip Webster Bernard Burrow + bipedicled mucosal advancement buccal mucosa
What do you do to reconstruct the commissure
rhomboid mucosa flap
What muscles insert onto the modiolus
LAO, ZM, O.Oris, Buccinator, risorius Fx: all shift the lateral commisure
What muscles insert onto upper lip
LLS LLSan Zm Fx: elevate upper lip
What muscles insert onto lower lip
mentalis, DLI, plastysma Fx: depress lower lip, except mentalis ELEVATES lower lip
What is the lymphatic drainage of the upper and lower lips?
Upper lip and lateral lower lip -> submandibular Central lower lip: submental basin
What are your goals of lip reconstruction
Aesthetics -Skin, lining, vermilion reconstruction Function - sensation - stoma opening (denture) - competence - Buccal sulcus - speech
Describe the FAMM flap
facial artery musculomucosal flap Based on facial artey - raise mucosa, submucosa, buccinator, facial artery
What are the subunits of the lower lip?
chin vermilion white lip
Describe a step ladder advancement flap
suitable for defect of lower lip up tp 1/2 if width of defect is x, width and height of step is 1/2x Will need 2-4 steps If defect midline, use stairsteps bilateral, if defect lateral, use unilateral step ladder
What are indications for a karapandzic flap?
Upper lip 1/2 defect Lower lip 2/3 defect
Describe a karapandzic flap
From the defect, draw falps of equal height extending along NL folds or menton crease - except at commisure, go beyong NLfold/menton to ensure flap is equal width throughout. Width=Height Skin incision then dissect to release O.oris throuhg whole flap but leave mucosa in tact to preserve NV supply (labial arteries)
Describe an Estlander flap
Used for defects which include commissure Actually a rotation flap, no dissection of pedicle as in Abbe - rotate commissure to meet defect vermilion.
Describe a gilles fan flap
extension of estlander rotation advancement of white lip adjcant to NL fold No preservation of innervation
Describe the DAO flap
skin DAO and buccal mucosa is rotated from commisure to midline need neovermilion
Describe the bilateral gilles fan flap
indicated for 2/3 -total lower lip defect bilateral rotation flaps - no nerve supply to o.oris maintained
Describe the webster Bernard Burow
Bilateral horizontal advancement flaps, burrow triangles in NL fold and paramental folds - skin and subcut eccision of burow triangles only.
Describe the fujimori gate flaps
Inferiorly based nasolabial flaps
Describe regional flap options for lower lip defect
pectoralis, SCM, deltopectoral, fasciocutaneous scalp/temporal flaps
Describe free flap options for lower lip recon
USed if failed local, hx radiation, composite requiring bone, FOM RFFF +/- PL fibula scapula ALT +/- fascia lata
Describe management options for upper lip defects (
primary closure A to T Perialar crescentric adv flap Nasolabial flap Abbe flap Reverse estlander
Describe management for philtral defect
1’ closure STSG abbe
Describe options for defects of lateral and philtral less than 2/3
bilateral crescentric perialar flaps reverse karapandzic
Upper >2/3 defect options
need combination abbe and bilateral NL abbe and reverse karapandzic Upper lip webster bernard burrows
Whata re reional flap options for recon of upper lip
TPF
What are options for local flap reocn of cheek defect
rhomboid flap transposition flap bilobed flap nasolabial flap V-Y advancement sickle shaped flaps cheek advancement
Describe an anteriorly based rotatationadvancement flap
Juri and juri flap (based on facial and trasnverse cervical) designed form teh superior edge of defect, along Z arch, preauricular rease, behind ear to follow occipital hairline If insufficient and include neck and chest bu going posterior to trapezius and lateral to AC joint then returnign to chest abouve NAC
Describe posteriorly based rotation advancement flap
based on STA, perforators from TA and trapexius
Describe pectoralis muscle flap
type 5 - based on TA pectoral br and perforators from IMA
Describe regional flap options for cheek reconstruction
pectoralis Deltopectoral trasnverse forehead flap TPF platysma, SCM
Describe an abbe flap
Based on inferior labial artery or superior labial artey, full thickness flap wedge -
wdith of flap is deisgned to be 1/2 width of defect and height is made to made (except for 2’cleft lip revision where width is designed to be equal
Pedicle should be at the midlin eof the defect when designing
what % defect of upper lip and lower lip can you close primarily with a wedge?
upper lip 25%
lower lip 30%
