Introduction. In all surgical reconstructions of the lower lip, starting from the direct closure after a cuneiform excision of the malign lesions up to surgery of a wide lip reconstruction with advanced transversal labio-mental flap, it is created a perpendicular cicatricial line with a high risk of the fibrotic retraction of vermilion. We propose the crossing of musculocutaneous perpendicular cicatrix with a vermilion flap, to break the forces of perpendicular fibrotic contraction.
Case reports. We present four cases of lower lip carcinoma. In two of them, cuneiform excision was done, and in the other two a rectangular excision. In cases with cuneiform excision, the defect was closed with direct suturing, while in the others with rectangular excision, the lip reconstruction being done with a Schuchardt flap. In all cases, a vermilion flap was applied to prevent perpendicular fibrotic retraction of the lip. Biopsy reports showed a well-differentiated squamous cell carcinoma (SSC) in one case, a poorly differentiated SSC in two others, and a basal cell carcinoma (BCC) in the last case. In all cases, the margins were free of neoplastic infiltration.
Conclusions. In the reconstruction of the lower lip with transverse advancement surgery, it is good to cross the perpendicular labio-mental musculocutaneous suture with a vermilion flap, to avoid postoperative fibrotic retraction of the lip, protecting the linearity of the vermis, as well as providing functional security and satisfaction aesthetic of the patient.
Keywords: lower lip, basal cell carcinoma, squamous cell carcinoma, vermilion flap.
Full text sources https://doi.org/10.31688/ABMU.2023.58.2.14
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Helidon NINA
Department of Surgery, Faculty of Medicine, University of Medicine, Tirana, Albania
Address: Rr. Dibrës, No. 71, Tirana, Albania
E-mail: ninahelios@yahoo.com; Phone +35 569 218 0094
