Extended Karapandzic flaps for near-total and total lower lip defects

Background: Karapandzic flaps consist of well-vascularized, sensate lip tissue but are generally restricted to reconstruction of defects comprising two-thirds of the lip or less to avoid microstomia. Reconstruction of larger defects usually involves advancement flaps that require significant cheek laxity or free tissue transfer. Methods: The authors describe a modification of the Karapandzic lower lip reconstruction technique in which the flaps are extended by recruiting tissue from the perioral cheek, allowing reconstruction of near-total and total lower lip defects, which would normally not be reconstructible using the standard technique. Neurovascular structures are carefully dissected and preserved to ensure innervation and perfusion. Results: Eight patients underwent successful single-stage lower lip reconstruction with this technique. In three cases, bilateral extended Karapandzic flaps were used for total lower lip defects, and in five additional cases, unilateral extended Karapandzic flaps were combined with other local flaps for near-total defects. All patients achieved oral competence and normal or near-normal mouth opening. One patient developed a hematoma and one patient developed a fistula that healed with conservative treatment. There were no other complications. Conclusions: Extended Karapandzic flaps can be used to reconstruct near-total or total lower lip defects with innervated, well-vascularized tissues that recreate the oral sphincter and restore oral competence. By extending conventional Karapandzic flaps with perioral cheek tissue, adequate length is gained to avoid microstomia. In addition, the color match of the reconstructed lip is superior to reconstructions relying on tissue transfer from distant sites.