xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Larrabee & Moyer

430

Fig. 5. Lip mucosal advancement flap. ( A ) Patient with a 4.3 cm 2.0 cm lip defect after Mohs micrographic sur gery for a squamous cell carcinoma of the midline lip. ( B ) A large mucosal advancement flap was elevated down to the gingivolabial sulcus. Standing cutaneous deformities were removed in the leading edge laterally. ( C ) The wound was closed with interrupted 4-0 chromic, and then a running 5-0 fast gut was used to attach the skin to the mucosa.

muscles. 3 As the flap is advanced medially, its base often overlaps the oral commissure; this redun dancy of skin may require excision. 3 With medial advancement of the flap, the oral commissure

may be pulled superiorly or inferiorly. The displace ment of the oral commissure may be self-correcting as the natural pulling of the lip musculature causes a corrective adjustment over time ( Fig. 6 ). 3

Fig. 6. Lip advancement flap. ( A ) Patient with extensive squamous cell carcinoma of the right upper lip with peri neural involvement. ( B ) The closure of the full-thickness central portion of the defect was performed with mucosal advancement flaps. The lip defect was closed with a large lateral lip and cheek advancement flap with the standing cutaneous deformity being removed superiorly in the peri-alar region. ( C, D ) Postoperatively, a lip asymmetry was present from loss of buccal nerve function. ( E ) Two years postoperatively after a right scar revision Z-plasty and cheek lift to reestablish right melolabial crease. Four years postoperatively after the original lip advancement.