Table 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Source publication
Background
Lip reconstruction for defects greater than 80 % present a challenge in maintaining acceptable oral function and good aesthetic results. Abbé flaps offer an excellent reconstructive option but are limited to defects under 65 %.
Methods
We describe a two-stage “modified Abbé island flap” technique whereby a full-thickness myocutaneous fl...
Contexts in source publication
Context 1
... were followed-up every two months for the first year, four months for the next two years and once a year up to five years post-surgery. The final functional and aesthetic outcomes were measured by using a spe- cial form developed in our clinic and completed for each patient at least one year post surgery (Table 2). To re- duce observer bias, a protocol for recoding the results was put in place. ...
Context 2
... underwent regular follow-ups without any tumor recurrences noted during this period. Table 2 presents the results obtained in the case of four patients, at least one-year post surgery. Two patients were lost to follow up after the one-year and one-year and eight months visit respectively. ...
Citations
... 1,2 The Abbe flap can be used for lip reconstruction with medial defect, and Estlander flap can be used if the defect is on the lateral lip and has commissural involvement. 1,2,4,5,8,10 The use of these two flaps can maintain orbicularis oris muscle competence. Facial animation can be preserved with Abbe flap, but Estlander flap is an insensate flap that changes the position of the modiolus, causing oral and facial animation to be distorted. ...
... 4,7 Design of the Abbe donor flap can be triangular or "V" in shape, or it can be modified to a W-shaped, rectangular, or other configuration based on the defect. 4, 8,10 In our patient, the donor flap was a triangular design, and the same size as the defect. ...
Background: Reconstruction of upper lip defect is challenging, because the upper lip is formed by two lateral nasolabial subunits and one philtrum subunit. The most effective reconstruction approach for upper lip deformities is still being debated. Purpose: To report a case of upper lip defect, and review the Abbe flap and Estlander flap methods for upper lip reconstruction. Case report: A 62 years old female subject with full thickness defect of two third of the upper lip, repaired by Abbe flap. Clinical question: What is the best surgical preference for upper lip defect reconstruction? Review method: A systematic literature search based on clinical questions, inclusion, and exclusion criteria in the PubMed, ProQuest, EBSCO databases, Scopus and hand searching using keywords. Result: No eligible studies were pertinent to answer the clinical question. Conclusion: Reconstruction options of upper lip defect were based on thickness, size and the defect in the structure involved. The Abbe flap can be used to reconstruct the full thickness medial upper lip, one-third up to two-thirds of the defect area. Lateral defects and commissure involvement can be repaired by Estlander flap. ABSTRAKLatar belakang: Rekonstruksi defek bibir atas lebih sulit, karena dibentuk oleh dua subunit nasolabial lateral dan satu subunit filtrum. Pendekatan rekonstruksi yang paling efektif untuk kelainan bentuk bibir atas masih diperdebatkan. Tujuan: Untuk menyajikan kasus defek bibir atas, pilihan terapi untuk pasien ini dan meninjau pilihan metode operasi dengan jabir Abbe dan Jabir Estlander untuk rekonstruksi bibir atas. Laporan kasus: Seorang wanita 62 tahun dengan defek dua pertiga bibir atas dengan ketebalan penuh, yang direkonstruksi dengan jabir Abbe. Pertanyaan klinis: Apakah pilihan bedah rekonstruksi terbaik untuk defek bibir atas? Telaah literatur: Pencarian literatur sistematis berdasarkan pertanyaan klinis, kriteria inklusi dan eksklusi di database PubMed, ProQuest, EBSCO host dan pencarian tangan menggunakan kata kunci. Hasil: Tidak didapati studi yang memenuhi syarat untuk menjawab pertanyaan klinis. Kesimpulan: Pilihan rekonstruksi untuk defek bibir atas adalah berdasarkan ketebalan, luas, dan kecacatan pada struktur yang terlibat. Jabir Abbe dapat digunakan untuk rekonstruksi medial bibir atas dengan ketebalan penuh sepertiga hingga dua pertiga dari area defek. Defek lateral dan keterlibatan komisura dapat diperbaiki dengan jabir Estlander.
... En cambio, los tumores de labio inferior que afectan a más de un 75% de la superficie del mismo requieren de reconstrucciones más complejas, precisando la realización de colgajos de avance y rotación que garanticen el cierre del defecto y la preservación de las funciones de los labios junto con el mejor resultado estético posible. De entre los distintos tipos de colgajos de reconstrucción existentes [5], el colgajo descrito por Karapandzic en 1974 [6] se ajusta perfectamente a las necesidades anteriormente descritas de mantenimiento de la función de la cavidad oral junto con un excelente resultado estético. La exéresis del tumor de labio inferior junto con los márgenes de seguridad adecuados ofrecía un defecto de superficie cuadrangular cercano al 80% de la superficie total del labio inferior, que se reconstruyó cuidadosamente para preservar la estética facial y las funciones de los labios (Figura 2). ...
Introducción: El carcinoma de labio inferior es una enfermedad relativamente frecuente que precisa tratamiento quirúrgico para su resolución. La reconstrucción del defecto quirúrgico cobra importancia a la hora de preservar las funciones de la cavidad oral y la estética facial. Descripción: presentamos un paciente con carcinoma de labio inferior que requiere una amplia exéresis y su reconstrucción mediante un colgajo de Karapandzic. Conclusiones: La reconstrucción del labio inferior mediante la realización de un colgajo de Karapandzic permite la exéresis de tumores extensos de labio inferior con la preservación de las funciones del mismo y unos resultados estéticos excelentes.
Purpose of review
This review describes the fundamental principles and recent advances in the reconstruction of total lower lip defects to restore peri-oral aesthetic and function.
Recent findings
Modifications to the Abbe flap and visor flap have recently been described. Recent advances to free flap techniques have focused on dynamic restoration of lower lip sling function after reconstruction. This involves the transfer of innervated or noninnervated muscle tissue to reconstruct the lower lip to restore the sphincter function of the lips.
Summary
The reconstructive goals for a full thickness lower lip defect are to restore a functional oral sphincter, replace mucosal and external skin, and maintain a functional size of the oral aperture. Local flap reconstruction of sub-total lower lip defects is possible, but use of local flaps for total lip reconstruction often leads to microstomia. Several static and dynamic free tissue transfer options exist for lower lip reconstruction and have been summarized in this review.
Background:
The Abbe flap is a common technique frequently utilized in secondary surgery for bilateral cleft lip deformities, but objective indications for the Abbe flap remain unclear, and postoperative aesthetic evaluations are limited.
Methods:
The study group consisted of 92 bilateral cleft lip patients with secondary deformities aged 7-39 years, and the control group consisted of 33 people aged 19-35 years. Thirteen objective nasolabial aesthetic parameters were selected to evaluate patients' nasolabial aesthetics.
Results:
Minor secondary deformities were characterized by a smaller lip height index than severe deformities, as well as a smaller columellar angle compared with moderate and severe deformities (P < 0.05). For all patients, significant differences were found between preoperative and postoperative values of intercanthal distance/medial upper vermilion height ratio, intercanthal distance/medial upper lip height ratio, lip height index, lip vermilion height index, lip protrusion angle, columellar-labial angle, and nasal tip angle (P < 0.05). For patients with minor deformity, intercanthal distance/philtrum width ratio and intercanthal distance/medial cutaneous upper lip height ratio showed no significant change postoperatively (P > 0.05), and labial protrusion angle was smaller than the control group (P < 0.05).
Conclusions:
Patients undergoing secondary surgery using an Abbe flap achieved good nasolabial aesthetics. Intercanthal distance/medial upper vermilion height ratio, intercanthal distance/medial upper lip height ratio, lip height index, columellar-labial angle, nasolabial angle, nasal tip angle, and columellar angle are the objective aesthetic indicators for Abbe flap selection. Intercanthal distance/philtrum width ratio, intercanthal distance/medial cutaneous upper lip height ratio, and labial protrusion angle are reference parameters for choosing an Abbe flap for secondary bilateral cleft lip revision.
Purpose of review:
This article reviews recently described techniques used to reconstruct lip defects. Emphasis is placed on the ability of these flaps to restore function and appearance of the lips as well as their limitations.
Recent findings:
The focus of recent advances in lip reconstruction has been to achieve better oral competence, speech and improved cosmetic appearance. New modifications to the traditional Karapandzic and Abbé flaps have expanded their uses. A host of novel local tissue transfer techniques has become available with improved outcomes and less morbidity. Similarly, new free tissue transfer methods have allowed for the creation of a more normal appearing lip with improved sensory and motor function. Although still experimental, tissue engineering of a mucocutaneous junction shows promise in its ability to recreate a normal vermillion.
Summary:
Lip reconstruction techniques have continued to become more sophisticated in order to achieve better functional and cosmetic outcomes after resection. Several new local tissue and free tissue transfer techniques have recently been described and can be included in contemporary reconstruction algorithms.
Facial defects following Mohs surgery can cause significant functional, cosmetic, and psychologic sequelae. Various techniques for nasal reconstruction after Mohs surgery have been analyzed in the medical literature, yet there has been less attention given to procedures for other crucial facial aesthetic regions. A literature search using PubMed, EMBASE, and ISI Web of Science for studies assessing reconstructive techniques of the forehead, cheek, and perioral regions after Mohs surgery was performed. No limitations on date or language were imposed. Studies meeting inclusion criteria consisted of an entirely post-Mohs population, specified technique for aesthetic unit reconstruction, and detailed complications. The initial search yielded 2177 citations. Application of the author's inclusion and exclusion criteria resulted in 21 relevant studies. Linear closure was highlighted as the predominant technique when possible in all 3 aesthetic zones. Local flaps remained the workhorse option for cheek and forehead defects. Cheek and perioral reconstruction were associated with higher complication rates. Eighty-one percent of studies did not include patient-reported outcomes or standardized outcome measurement assessments. Mohs surgery has become a valuable approach for treatment of skin malignancies of the face. This review has identified significant study heterogeneity in methodology, design, and outcome assessment. Currently, there is no evidence-based literature to support an algorithm to guide surgeon choice of treatment in these 3 central areas. Recommendations are provided to improve the quality of future studies to better inform appropriate surgical technique for each facial unit analyzed.
Purpose
Local flaps are currently considered the main reconstructive option for medium-size oral and peri-oral defects; however, their indications are sometimes challenging to select. The aim of this study was to critically analyse their selection and to propose a therapeutic algorithm.
Materials and methods
We performed a search on PubMed regarding the medium-size oral and peri-oral defects reconstruction, and we collected data on the aetiology, the location of the defect, the type of flap used and postoperative complications. The final proposed treatment algorithm was the product of this analysis.
Results
We found 111 articles and 2504 flaps (236 buccinator flaps, 60 masseter flaps, 466 facial artery myomucosal flaps, 285 tongue flaps, 95 palatal flap, 525 buccal fat pad flaps and 835 local lip flaps). The most frequent defect localizations included floor of mouth (203 flaps), cheek (242 flaps), anterior hard palate (418 flaps) and upper and lower lip (274 and 559 flaps). Partial flap necrosis and dehiscence occurred in 3% of cases whereas total necrosis in 1%.
Conclusions
Local flaps are a good option for oral and perioral defect reconstruction. An appropriate choice of the flap to be used based on the location of the defect is essential for a correct reconstruction.
Introduction:
Lower lip reconstruction should restore oral competence, speech, and cosmesis. These goals are a challenge when reparing large lower lip defects. Karapandzic flap is a reliable technique with consistent functional and esthetic outcome. In large defects, it might result in disproportion between the upper and lower lips and blunting of the commissures. The Abbe flap is useful as a lip balancing procedure and avoids the rounding of the commissures.
Patients and methods:
Five cases of lower lip skin cancer treated with Mohs surgery with defects up to 80% were reconstructed with a combination of Karapandzic and Abbe flaps. All cases were performed under local anesthesia.
Results:
We observed no complications related to wound or flap survival. All patients preserved function. Esthetic outcome was considered very good to excellent in 4 cases and good in 1. Mild micrsotomy wad observed in 1 patient.
Discussion:
We believe that the standard Karapandzic and Abbe flap compares favorably with the modified Abbe plus modified Karapandzic flap combination in defects up to 80% because it is performed straightforward and can be done under local anethesia. Similarly, when compared with Karapanzic plus Burrow-Bernard-Webster combination in defects up to 80%, we believe that the standard Karapandzic and Abbe flaps are better both in function and in esthetics. In defects larger than 80%, both flap combinations are better than standard Karapandzic and Abbe flaps because of the risk of microstomy.
