The Step Technique for the Reconstruction of Lower Lip Defects After Cancer Resection:A Follow-up Study of 165 Cases

Abstract

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.

Reconstruction of the Lower Lip: Rationale to Preserve the Aesthetic Units of the Face

“…In cancer surgery, considering a 5-mm resection margin on both sides and the size of the tumor, the preservation of the labiomental fold is hardly possible when using this technique. 1 Even in the few cases in which this was possible without compromise of the natural folds, a notch resulted as a consequence of the disorientation of the orbicular muscle seen in pouting. 1,14,21 The rectangular excision, when using the step technique, allowed horizontal advancement of the re- Volume 120, Number 5 • Lower Lip Reconstruction maining lip, preserving the orientation of the orbicular muscle.…”

“…1 Even in the few cases in which this was possible without compromise of the natural folds, a notch resulted as a consequence of the disorientation of the orbicular muscle seen in pouting. 1,14,21 The rectangular excision, when using the step technique, allowed horizontal advancement of the re- Volume 120, Number 5 • Lower Lip Reconstruction maining lip, preserving the orientation of the orbicular muscle. Direct closure after wedge excision, despite its simplicity, showed a less satisfactory aesthetic result than that achieved with the step technique.…”

“…The prognosis for lip cancer patients is favorable, with a 5-year survival rate between 80 and 98 percent. 1,2 The goals of plastic reconstruction of the lip are an excellent aesthetic and functional result. 3,4 Since the middle of the nineteenth century, more than 200 different techniques for reconstruction of the lower lip have been described.…”

“…The commissure is is closed after a horizontal stepwise advancement of a lateral flap above the labiomental fold. 1,14 The aim of this study is to evaluate the aesthetic and functional outcome using the three techniques for lip reconstruction based on the concept of the aesthetic units of the face.…”

Réparations chirurgicales des pertes de substance labiale

“…La perte de substance ne doit pas être trop latéralisée. Si la perte de substance dépasse les 2/3 de la lèvre, il a été décrit la possibilité d'associer, à la technique de l'escalier, un lambeau en éventail de Gillies (ci-après) ou d'Abbe [23] : il est cependant plus simple, dans ces situations, de choisir une solution ne nécessitant qu'un seul lambeau de réparation, tel le lambeau de Karapandzic. Une variante du lambeau en escalier a été proposée pour les répara-tions de la lèvre supérieure [24].…”