xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Reconstruction of Mohs Defects of the Lips and Chin

Yuna C. Larrabee, MD , Jeffrey S. Moyer, MD *

KEYWORDS Lip reconstruction Chin reconstruction Cutaneous defects Lip neoplasms Local flaps Cutaneous malignancy Mohs micrographic surgery KEY POINTS The cutaneous and mucosal lips are critical structures of the face performing a vital role in oral func tion and competence as well as overall facial aesthetics. Attention to the aesthetic boundaries of the lip, cheek, and nasal subunits will result in the best reconstructive outcomes of the perioral region. Revision surgery, including Z-plasty, is often necessary to achieve the best long-term results.

INTRODUCTION

rather, continued advances in already accepted techniques. When reconstructing the cutaneous lip, it is preferable to confine tissue movement within the aesthetic region of the lips, unless this causes distortion of adjacent structures, such as the melolabial crease. 3 Local flaps generally pro vide the best match for the quality of the skin and mucosa of the lips. The focus of this article is on local tissue transfer for primarily cutaneous defects after Mohs surgery. The lips are a major component of the lower third of the face. The lip encompasses the area from the subnasale to the mental crease and from commissure to commissure ( Fig. 1 ). The lips are divided into the cutaneous, vermilion, and mucosal parts. Vermilion is specialized mucosa that covers the lips. Vermilion is divided into the dry (external) and wet (internal) vermilion. The white lip, or cutaneous lip, is made up of the non vermilion skin surrounding the lip. The cutaneous lip extends from the nasal base superiorly, to the ANATOMIC CONSIDERATIONS

The lips are prominent facial features important for both functional and aesthetic aspects of daily life. Defects from Mohs micrographic surgery can alter the normal lip appearance and impact patients’ self-image and their quality of life. Successful re pairs encompass both functional and aesthetic concerns. The goals of reconstruction are the restoration of oral competence, maintenance of oral opening, restoration of normal anatomy, and provision of an acceptable aesthetic outcome. 1 Defects of the lip are challenging to reconstruct for several reasons. There is an increase in the risk of anatomic distortion through increased wound contraction due to the lack of a substantial fibrous framework. The area is under constant motion, and wound contracture can lead to poor functional and aesthetic outcomes. As the lips are within the observational center of the face, even minor lip de fects require meticulous reconstruction to mini mize the distraction caused by the defect. 2 A review by Coppit and colleagues 1 in 2004 found no major advances in lip reconstruction but,

Disclosure Statement: The authors have nothing to disclose. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Taubman Center Floor 1 TC1904, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA * Corresponding author. E-mail address: Jmoyer@med.umich.edu

Facial Plast Surg Clin N Am 25 (2017) 427–442 http://dx.doi.org/10.1016/j.fsc.2017.03.012 1064-7406/17/ 2017 Elsevier Inc. All rights reserved.

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