Versatility of the estlander flap: upper lip, lower lip and comissure reconstruction due to a dog bite

Background: Dog bites continue to be a frequent cause for plastic and reconstructive services in the world. The grand majority of these cases affect the head and neck area; and more often than not they involve the commissure and the lips. The latter leading to an increased level of difficulty and a substantial decrease on the posibilities for a successful reconstruction. This case report focuses on the exploration of the Abbe-Estlander flap as an efficient alternative in most of these cases.Methods: We present two clinical cases involving dog bites where the affected area of both patients was estimated to be one third of the total volume of the lip. Both patients required emergency reconstructive surgery. An Estlander flap was successfully performed in both instances. The purpose of the article is to share the results and motivate the medical community to continue to use this method as a strong avenue for an effective recovery.Results: After two months of the surgery, the team followed up with both patients and they were satisfied with the results. Patient A presented adequate healing of the wound; a lack of alignment of the mucocutaneous rim and rounding of the commissure was observed. Phonation, oral continence without any leakage and complete closure of the lip were also part of the recovery assessment. Patient B presented adequate healing of the wound, phonation and medium oral continence with occasional leakage of liquids and incomplete closure.Conclusions: The Abbe-Estlander flap is still an excellent reconstructive alternative for upper and lower lip reconstruction where the affected area is up to one third of the total volume. As long as the commissure involvement represents minimum difficulty, both aesthetic and functional objectives can be successfully attained using this flap.

Application of tissue expansion in simultaneous reconstruction of nasal-lip defects / 中华医学美学美容杂志

Objective To investigate the operative technique and outcome of the expanded flap to repair the full thickness defects of nose and upper lip simultaneously.Methods Three kinds of ex panded flaps were chosen to reconstruct the full thickness defects of nose and upper lip.They were designed according to the location and the size of the defects,and also the circumstances of the donor site.Treatment effectiveness were observed by long-term follow-up.Results 7 patients were treated with the expanded flap.All cases received satisfactory results with no complications such as flap necrosis.And for male patients,the frontal expanded flap could reconstruct upper lip and beard simultaneously that reached better shape.Conclusions It is an ideal approach of repairing nasal-lip defects by the tissue expanded flap.

Fissura labiopalatina em idoso: relato de caso / Cleft lip and palate in an old patient: case report

OBJETIVO: Relatar o manejo de um caso de fissura labiopalatina transforame, unilateral, em paciente idoso. MÉTODO: Utilizou-se a técnica de Millard associada à rinosseptoplastia. RESULTADO E DISCUSSÃO: O resultado obtido foi bastante satisfatório. Entretanto, a existência de um idoso comfissura labiopalatina não tratada em pleno terceiro milênio mostra que ainda há muito que avançar em relação à política de atenção aos pacientes com anomalias craniofaciais.

OBJECTIVE: To present the surgical treatment of an elderly patient with untreated cleft lip/palate. METHOD: The Millard´s surgical technique was chosen for the correction of the lip and nose defects. RESULTS AND DISCUSSION: The achieved results of the surgicaltreatment were satisfactory. However, the existence of an untreated aged patient in the third millennium shows that there is still much to advance in the attention policy of patients with craniofacial anomalies.

Both Buccal Mucosa Transposition Flap for Reconstruction of Lower Lip Near-Total Mucosal Defect

PURPOSE: Squamous cell carcinoma(SCC) of the lower lip is the most common malignant tumor comprising 90% of all lip SCC. The typical picture of SCC of the lower lip is of an ulcerated lesion with raised margins. Surgery is the treatment of choice for SCC of lower lip. Depending on the location and size of the tumor, different types of flaps are used. We used new method ? 'both buccal mucosa transposition flap' for the reconstruction of the near total mucosal defect of the lower lip. METHODS: This 67-year-old men presented with the crusted 1x1cm sized ulceration of the lower lip that was arised 30 years ago. There were no size or color change, except the bleeding and ulceration. At first, We diagnosed the SCC through the incisional biopsy. Then We performed the wide excision of the tumor and reconstruction of the lower lip. After the excision of the whole tumor, the defect was measured at 8x3.5cm. We designed the buccal mucosa transposition flap taking care to avoid the parotid duct. The flap was made in a triangular shape for the reconstruction of defected lower lip. The donor site defect can be sutured primarily. RESULTS: A patient in this study had no postoperative complications such as necrosis, dehiscence, infection of the flap or donor site. Reconstructed lower lip is relatively close to that of the natural lip; More satisfactory aesthetic and functional results can be obtained by using this technique rather than other techniques. CONCLUSION: 'Both buccal mucosa transposition flap' is reliable method for the reconstruction of the large lower lip mucosal defect. The operation is simple and performed in one stage, with no postoperative complications. This technique can offer consistently good functional and esthetic outcomes after reconstruction of lower lip mucosal defect.

The Dynamic Lip Reconstruction with Variable Free Neuromuscular Transfers in Chronic Facial Palsy

The goals of ideal lip reconstruction in chronic facial palsy include recovery of sphincteric function of the lip and symmetry of mouth during facial expression and the resting state. The lip reconstruction in chronic facial palsy can be mainly divided into dynamic and static method. Recently, the dynamic lip reconstruction tend to be reported more frequently with the development of microsurgery. From December of 1994 to August of 2001, We had 6 dynamic lip reconstruction by one or two staged free neurovascular flap, and followed up from 1 to 4 years and 4 months (mean 36 months). One case was two-staged free rectus abdominis flap after cross-face nerve graft with sural nerve. Another case was one- staged free gracilis muscle flap anastmosised with one of the buccal branch of facial nerve in the affected side, which had relatively good function. The other 4 cases were one-staged free neurovascular latissimus dorsi flaps. We also combined other procedures such as gold implant for lagophthalmos, temporalis muscle transfer on ectropion of the lower eyelid, and the excisional eyebrow lift on the affected side. We got relatively satisfactory results except 1 case.

Treatment of squamous cell carcinoma on lower lip

The squamous cell carcinoma is the most common cancer of lower lip. Although various treatment methods have been introduced, surgical resection and reconstruction is considered to be the most important medical remedy. We surveyed 11 patients who received the surgery for squamous cell carcinoma on lower lip from January 1992 to December 1997. The survey included the size and location of tumor mass, the presence of lymph node metastasis for a preoperative evaluation, the aesthetic and the performance of lower lip after the operation, the recurrence rate, the complication and the mortality rate. In resectioning tunmor mass, the surgery has to completely remove the mass and meanwhile has to minimize the loss of normal tissues. Also in reconstruction of lower lip, it has to resemble, aesthetically and functionally, the normal lower lip as well. To achieve such s, the pre-excisional frozen biopsy was performed to determine the surgical margins and various reconstructive methods were tried according to the location and size of the defect remained in the lower lip. In the most of clinical cases, appropriate vermillion and nasolabial sulcus were fashioned and they functioned normally in both speech and mastication. As for complications, each case of drooling and macrostomia were reported, There was no mortality from lower lip carcinoma and its recurrence. Due to determination of the safe surgical margin by pre-excisional frozen biopsy and reconstruction by appropriate procedure according to the location and the size of defect, the survey indicates minimized postoperative complications, no recurrence and no mortality as well as aesthetically and functionally adequate lower lip