xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Mohs Defects of the Lips and Chin

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Fig. 16. Lip wedge excision with primary repair. ( A ) Wide local excision measuring 1.5 cm 3.0 cm. A 0.5 cm margin was marked around the right lower lip squamous cell carcinoma in a wedge-shaped fashion. The muscle layer was closed using 5-0 interrupted PDS (polydioxanone suture). ( B ) Postoperative appearance.

flaps is the similarities of tissue texture, muscular composition, and appearance of the donor and recipient site. The Abbe flap is used for defects medial to the oral commissure. The Estlander flap is used for defects involving the oral commissure. After full-thickness resection from the lower lip, the upper lip triangular full-thickness flap is designed to have the same height as the defect with a width one-half to two-thirds of the defect size. 2 The blood supply to the flap is from the labial artery, which should be preserved when raising the flap. After insetting the flap, the divi sion of the pedicle can be performed after 14 to 21 days ( Fig. 17 ). 2

closure. The vermilion edges must be re approximated precisely as even small irregularities can be conspicuous. 2 Before wedge excision, it is helpful to mark the vermilion. 1 Closure begins with placement of the suture to re-approximate the vermilion border. 2 The orbicularis muscle is closed with absorbable suture, and the exposed and intraoral components of the red lip can be closed with chromic suture. 2 Medium-sized full-thickness lip defects The ideal reconstruction of a lip defect that is be tween 30% and 60% of the horizontal lip is an Abbe or Estlander flap . The advantage of these

Fig. 17. Abbe flap. ( A ) Patient with a full-thickness upper lip Mohs defect measuring 4.1 cm 2.3 cm. ( B ) Design of an inferiorly based Abbe flap based medially. Bilateral advancement flaps were used to decrease the width necessary for the lower lip secondary defect. Arrows depict the vectors of advancement. ( C ) The lower lip full thickness Abbe flap on its pedicle is shown. The inferior lip was closed with an M-plasty. ( D ) Inset of Abbe flap. ( E ) Postoperative appearance before the detachment of the flap performed 21 days later.