xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Mohs Defects of the Lips and Chin

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Fig. 13. Lip rotation-advancement flap. ( A ) Patient with a cutaneous and mucosal lip defect measuring 3.4 cm 1.3 cm. ( B ) Markings showing planned mucosal advancement flap, with arrows depicting the vectors of advancement; left lip advancement flap closure of the 1 cm 1 cm left medial lip defect; rotation advance ment flap closure from the right cheek of a 2.4 cm 0.5 cm cutaneous lip defect of the right lip lateral to the right philtral column. ( C ) Closure closed deeply with 5-0 Monocryl; vertical portion of the lip was closed with ver tical mattress of 5-0 nylon, and then the peri-alar crescent in the right alar groove was closed with a combination of vertical mattress and 5-0 nylon. ( D ) Postoperative appearance before surgeries done to correct lip volume. ( E ) Postoperative appearance 4 months after an upper lip implant and lip expander.

mobile skin and fat in the inferomedial cheek. The note flap was described by Walike and Lar rabee, Jr 8 as an angular transposition flap with a design that resembles a musical eighth note. A note flap allows closure of a circular defect with a triangular transposition flap ( Fig. 14 ). An advantage of note flaps is a decreased likelihood

required, small Burrow triangles can be excised ( Fig. 13 ).

Note flap A note flap is a transposition flap that can be used to repair lateral cutaneous lip defects. This flap for lip repair takes advantage of the

Fig. 14. Note flap design. The note flap is designed to look like a musical eighth note. It can be used for defects that are less than 2 cm in size. One side of the flap is drawn parallel to relaxed skin tension lines and in a tangent to the defect. This line should measure 1.5 times the diameter of the defect. The second side of the flap forms a 50 to60 angle with the first side and is the same length as the diameter of the defect. The arrows indicate the direction of maximum tension. ( From Baker SR. Transposition flaps. In: Baker SR, editor. Local flaps in facial recon struction. 2nd edition. St Louis (MO): Mosby; 2007. p. 137; with permission.)