Outcomes Following V-Y Advancement Flap Reconstruction of Large Upper Lip Defects

Abstract

Objective To characterize revision surgery following V-Y subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects. Methods Retrospective review of upper lip skin defects ≥3.0 cm2 that were reconstructed with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center. Depth and area of the defect, as well as involvement of the vermilion and nasal ala, were recorded as independent variables. Revision techniques were analyzed to identify patterns. Results Thirty patients were identified with upper lip skin defects ranging from 3.0 to 14.0 cm2 (mean 7.0 cm2, median 6.25 cm2). The defect involved the nasal ala in four cases and the vermilion in three cases. At least one revision surgery was performed in 14/30 (47%) patients. Alar or vermilion involvement was a significant factor in revision by chi-square analysis (p=0.026). Larger defect size did not predict a need for revision, even among cases where the defect did not involve the ala or vermilion (p=0.68). Conclusion Reconstruction of large upper lip skin defects with a V-Y subcutaneous tissue pedicle advancement flap is associated with a 47% revision rate, and when the defect involves the ala or vermilion, the revision rate is increased. Defect size alone cannot be used to predict the need for revision surgery. Revision techniques are demonstrated.

Postoperative Outcomes of Local Skin Flaps Used in Oncologic Reconstructive Surgery of the Upper Cutaneous Lip: A Systematic Review

“…Six studies reported outcomes on V-Y advancement flaps with the number of patients ranging from 13 to 109 with a range of upper lip defect locations with and without the involvement of neighboring cosmetic unit borders. [9][10][11][12][13][14] There was a single study on ergotrid flaps for upper lateral lip defects, 15 unspecified rotational flaps for apical triangle defects, 16 melolabial rotational flaps for apical triangle defects, 17 Karapandzic flaps for lateral upper lip defects, 18 alar crescent flaps for central upper lip defects, 19 and propeller facial artery perforator flaps for lateral upper lip defects. 20 Overall, there was significant heterogeneity in the complications as well as functional and aesthetic outcomes reported.…”

Advancement flap to cover a defect between the junction of the alar base and the upper lip

“…The V-Y Advancement Flap 3 places scars along aesthetic borders, but can result in elevation of the red lip due to scar contracture. The Keystone Flap 4 would result in the raising of the upper lip and blunting of the oral commissure.…”

Modification of the position of the angulus oris with a rotation flap and a YV flap in lip reconstruction

“…In such cases, it is preferable to reconstruct the defect with a local flap to facilitate a good color and texture match. The use of VY flaps, rotation flaps, Abbe flaps, and combinations thereof in lip reconstruction has been reported [3][4][5][6]. However, no reports have described a surgical technique to obtain positional symmetry of the angulus oris.…”