The “Frogger Flap”: A Novel Quadruple Rhomboid Flap for Complex Central Upper Lip Reconstruction

Abstract

Summary: Upper lip reconstruction represents a unique challenge for the reconstructive plastic surgeon. Given its prominent aesthetic role in addition to its functional role in facial expression, speech, and oral intake, preservation of this region’s natural form and function is paramount. In this report, we present a novel technique for the reconstruction of a complex central upper lip defect, restoring the natural aesthetic of this essential structure. We describe the case of a 51-year-old woman who presented with recurrence of a previously resected basal cell carcinoma center on the upper lip at the level of the white roll and philtral depression. Following surgical resection via Mohs micrographic surgery, a 1.8 × 1.6 cm partial-thickness defect centered around the Cupid bow involving both cutaneous and vermillion tissues remained. Reconstruction was achieved through a novel quadruple rhomboid flap primarily based on the preservation of the aesthetic subunits of the upper lip. A functional and aesthetic reconstruction was achieved through local tissue rearrangement, restoring the appearance of the white roll and red line. Native perfusion and innervation were preserved during the reconstruction of the Cupid bow, recreating this region’s natural appearance. The design of the flap resembles a jumping frog, which is the etiology of the “Frogger flap” moniker. The Frogger flap recreates the natural aesthetic of the central upper lip through the geometric transposition of tissue commensurate with native anatomy. Through the application of aesthetic subunit principles, it reliably reconstructs central upper lip defects while preserving function and providing an aesthetically pleasing outcome.

Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle

“…This technique avoided the 2-stage surgery while ensuring cosmetic appearance as well as functional restoration of the lip 20. Robinson et al4 designed a frogger flap, which reliably reconstructed central upper lip defects while preserving satisfactory function and aesthetics.…”

“…In an attempt to overcome these difficulties, many surgeons are working tirelessly. [2][3][4] The ideal reconstruction should adhere to the principle of replacing "like with like." 5 In other words, the ideal flap is supposed to be with characteristics similar to the lost tissues in terms of mucosal sensitivity, color, texture, volume, and consistency.…”