xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Larrabee & Moyer

438

Fig. 18. Estlander flap. ( A ) Patient with a left upper lip basal cell carcinoma with defect measuring 4.5 cm 4.0cm. A unilateral Estlander-type flap was designed along the left lip. ( B ) Immediate postoperative result.

The upper lip anatomy is more complex than that of the lower lip. Thus, upper lip defects require special attention. For defects involving more than 50% of the subunit, the entire subunit should be reconstructed. 2 The flap is designed using a template from the intact contralateral subunit ( Fig. 18 ). Large-sized full-thickness lip defects The Gilles fan flap can reconstruct full-thickness defects involving 70% to 80% of the lip. This flap uses a full-thickness pedicle, allowing for redistri bution of the remaining lip ( Fig. 19 ). 2 Karapandzic modification uses incisions through only skin and mucosa to preserve the musculature ( Fig. 20 ). 2

Muscle is released as required for closure of the defect by spreading parallel to the muscle fibers. 2

Commissuroplasty and other revision surgery Commissuroplasty is performed to correct micro stomia or rounding of the commissure that can occur after lip reconstruction. For example, commissuroplasty is generally required after an Est lander flap because the flap causes the commissure to be blunted and rounded. The simplest method of commissuroplasty was originally described by Converse and Wood-Smith 11 as a horizontal full thickness incision at the blunted commissure extending laterally to have the same horizontal extension as the contralateral side ( Fig. 21 ). 3

Fig. 19. Gilles fan flap design. ( A ) Defect of the lower lip has been excised. A full-thickness pedicle allows for redistribution of the remaining lip. ( B ) Closure of the incision lines. ( From Ishii LE, Byrne PJ. Lip reconstruction. Facial Plast Surg Clin North Am 2009;17:451; with permission.)