Reconstruction of a large lower lip defect using a combination of Abbe and staircase flaps: a case report

Lip defects often occur following wide excision as a surgical treatment for squamous cell carcinoma of the oral cavity. Defects larger than one-half of the lip cannot be closed primarily and require flap surgery. Reconstruction of the oral sphincter function can be achieved by means of a local flap using the like tissue, rather than with a free flap utilizing different tissues. A defect of the lower lip requires reconstruction using different techniques, depending on its size and location. Herein, we present the case of a patient exhibiting a lip defect spanning more than two-thirds of the lower lip, after a wide resection due to squamous cell carcinoma. The defect was reconstructed using an Abbe flap and a staircase flap. Revision was performed after 16 days. The patient’s oral competencies were fully restored 3 months postoperatively, and the esthetic results were ideal. Based on our experience, a combination of the Abbe and staircase flaps can produce excellent functional and esthetic outcomes in the reconstruction of a lower lip with a large defect. It can serve as a reliable reconstruction option for defects spanning more than two-thirds of the lower lip, not including the oral commissures.

Hybrid Reconstruction of the Upper Lip Following Major Cancer Resections

Major defects of the Upper lip due to cancer surgery are relatively less common compared to Lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise, microstomia and oral incompetence may result. The Upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an Abbe Flap to reconstruct the central unit of Upper lip, associated with Karapandzik flaps from both sides. Use of a Lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the Lower lip

Upper lip reconstruction post major cancer resections using the hybrid concept

<p>Major defects of the upper lip due to cancer surgery are relatively less common compared to lower lip. Standard techniques such as Karapandzic’s are capable of reconstructing up to fifty percent of the lip otherwise microstomia and oral incompetence may result. The upper lip has few aesthetic characteristic details due to the philtrum, its columns and cupid’s bows. Here we are proposing incorporation of an abbe flap to reconstruct the central unit of upper lip, associated with Karapandzic flaps from both sides. Use of a lip sharing concept has an additional advantage of producing harmony to the reconstructed region, and avoidance of crowding phenomena to the lower lip.</p>

The hybrid concept in lip reconstruction

<p>Local tissues are best suited for lip reconstruction. The defect following cancer resection is often significant where standard methods are often suboptimal. Here we are presenting 3 such cases. Case 1, a 65 years old male post squamous cell carcinoma (SCC) resection with 50% defect of lower lip and a commissure, reconstructed with Estlander flap and a unilateral Karapandzik flap on opposite side. Case 2, a 35 years old male had a similar kind of defect, reconstructed with Estlander flap and step-plasty on opposite side. Case 3, a 70 years old female with 80% central lower lip defect post SCC resection, was reconstructed with bilateral Karapandzik flaps and an Abbe flap. Considering the significant size defect, all cases healed quite satisfactorily. They maintained their oral competence with negligent microstomia. The hybrid principle of combining various reconstructive techniques is highly recommended for major lip defects.</p><p> </p>

Repair of Lip Defects with the Abbe and Estlander Flaps

Repair of lip defects with Abbe and Estlander flaps requires a thorough knowledge of lip anatomy and physiology in order to achieve a successful outcome. Both the Abbe and Estlander flaps are unipedicled lip flaps that transfer tissue from one lip to the other. The Abbe flap is extremely useful for repairing moderately sized defects of either lip but requires a second stage to divide the vascular pedicle. The Estlander flap is a “terminal” Abbe flap at either commissure and does not require a second stage. This chapter will discuss the technical details for the performance of these lip flaps.