Lip Recontruction

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Lip recontruction

Defect < 1/3 of lip simple excision with primary closure Defect 1/3 2/3 of lip Lip-switch (Abbe-Estlander) Johansson stepladder flap Defect > 2/3 of lip Gilles fan flap Bilateral advancement flaps Karapandzic Free radial forearm with palmaris longus tendon Large defects Webster or Bernard procedures using lateral nasolabial flaps with buccal advancement Aggressive and advanced-staged lesions Perineural spread should be performed at the time of resection. Potential biopsy of the mental nerve with a retrograde dissection in an attempt to obtain a negative margin should be considered With extensive perineural invasion, a drill-out of the mental nerve or hemimandibulectomy may be required

- Estlander flap is based laterally on the commissure - Abbe flap rotates a point medial to the commissure - Both rely on the labial artery and vein - Both can be superior or inferiorly based and can reconstruct defects up to 2/3 of the lip

Abbe flap

Estlander flap

Perialar crescentic advancement flap

Depressor anguli oris flap

Regional and free flaps

Vermilionectomy and laser ablation