Functional and aesthetic outcome of different methods of reconstruction of full thickness lip defects

Abstract

Background: The lip has functional and aesthetic importance. Lip defects occur due to the variety of etiology and the choice of their reconstruction has profound effect on functions and cosmesis. There are multiple options available for reconstruction according to defect size, but superiority of one method over another is still debated and hence the methods and their outcome were analyzed prospectively. Material and method: Twenty-one patients with all sizes and locations of defects in upper and lower lip with acquired etiology were included in the evaluation. Reconstruction was performed according to defect size, availability of local/regional and distant donor tissue, defect location, patients’ comorbid conditions and patients’ preference. Patients were assessed at 1 month and 6 months postoperatively. Observers’ and patients’ input were also taken into account for outcome. Results: Out of 21 patients, 5 free radial artery forearm flap reconstructions, 4 nasolabial flap reconstructions, 5 primary closures of defect, 4 Estlander flap reconstructions, 2 lip advancements, and one Karapandzic flap reconstruction were done. Free flap and nasolabial flap had hypoesthesia and incompetence if commissure is reconstructed and problem of bulk, restricted mobility and vermilion mismatch. Local and lip flaps were associated with decreased stoma size and some form of local scarring and asymmetry. However, all patients were satisfied with the functional and aesthetic outcome. Conclusion: Local flaps are better in terms of functional and aesthetic outcome but with some degree of microstomia which was well tolerated by most patients. Regional and distant flaps provide reconstruction where no other option is available and provide good functional support and acceptable cosmesis.

Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients

“…Shaikh et al [4] conducted a lip reconstruction study utilizing the same scale employed in our research. In their cohort of 21 reconstructions, 14.3% demonstrated subjective microstomia, and 57.2% exhibited objective microstomia.…”

“…Our study has notable limitations, including the exclusion of free flaps, which, although complex and carry a high risk in elderly patients with comorbidities, can be an excellent reconstructive option when performed by an experienced microsurgeon. These procedures are particularly effective for patients with defects exceeding 80% of the lower lip with involvement of the chin region [4,[35][36][37].…”

“…After 1 month, and in the late follow-up period, any alteration of lip functionality was assessed by considering 3 main aspects: static lip functionality, dynamic lip functionality (during food and drink intake), and alteration in phonation. For the assessment of potential microstomia, the valuable scale proposed by Shaikh et al [4] was used. This scale comprises both subjective parameters reported by the patients and objective parameters recorded by the medical staff during follow-up visits (Table 2).…”

“…Criteria for microstomia assessment. Adapted from Shaikh AI et al[4]. The functional and aesthetic outcome of different methods of reconstruction of full-thickness lip GMS Interdiscip Plast Reconstr Surg DGPW.…”

Prevention and treatment of microstomia

“…The mouth, a distinct structure in the lower third of the face, is a unique mobile organ that serves both cosmetic and functional purposes [ 1 - 4 ]. Although it typically maintains a specific anatomical position and size, preferences for the size of the mouth vary according to individual, racial, and societal factors, resulting in an ambiguous definition of microstomia [ 3 , 5 , 6 ]. As a result, subjective judgment significantly influences the diagnosis of microstomia.…”