xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Mohs Defects of the Lips and Chin

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Fig. 3. Lip musculature. ( From Drake RL, Vogl W, Mitchell AWM. Gray’s anatomy for students. Philadelphia: Churchill Livingstone; 2005; with permission.)

mucosal flap does not provide sufficient bulk. 2 A free buccal mucosal flap can be used for coverage of nonvisible portions of the mucosal defect and for coverage of the mucosal donor site. 2

Mucosal Lip Labial mucosal advancement flap

Defects involving the vermilion only can be recon structed with a labial mucosal advancement flap ( Fig. 5 ). Mucosal incisions are made toward the gingivobuccal sulcus, and mucosa is elevated off of the orbicularis oris muscle. 2 The flap has a 2:1 length-to-width ratio, and a back cut is included if needed to allow for advancement of the flap into the defect. 5 A pedicled orbicularis oris flap can be rotated into the base of the defect if muscle was removed with tumor and the

Central Cutaneous Lip Advancement flap

Cutaneous lip advancement flaps are most commonly used to reconstruct central cutaneous lip defects. 3 Dissection is in the subcutaneous plane superficial to the orbicularis oris and facial

Fig. 4. Lip primary repair. ( A ) Patient with a 1 cm defect of the left upper lip that is crossing the vermilion. ( B ) A mucosal advancement flap was created in the lower lip by dissecting the mucosa off of the orbicularis oris circum ferentially around the defect. Undermining was also performed circumferentially around the cutaneous portion of the defect. The vermillion was matched precisely, and standing cutaneous deformities were removed superi orly in the skin and inferiorly in the mucosal portion of the lip. ( C ) Postoperative appearance.