Reconstruction for extensive defects of the lip

Reconstruction for extensive defects of the lip requires restoration of both function and form. To maximally achieve this, one should first preferentially utilize remaining lip elements for reconstruction, even accepting a smaller but functional oral sphincter. One should next consider using adjacent cheek for lip, ultimately relying upon distant free tissue transfer when local tissue is insufficient. For defects ranging from one third to two thirds of the lip, cross-lip procedures, such as the Abbe flap, work well, and are often used in combination with local lip advancements to reduce the size of the transferred lip segment. Karapandzic flaps, providing innervated vascularized lip tissue, also work well for defects up to two thirds of the lip, but for larger defects, significant microstomia will result. In patients with sufficient cheek laxity, reconstruction of defects of up to two thirds and even greater can be accomplished without microstomia by cheek advancements, such as the Webster-Bernard procedure. One should utilize free tissue transfers, such as the radial forearm free flap, for near total lip defects or defects in which chin and other tissues are missing. Such repairs offer surprisingly good function despite the fact that at best they provide a static damn or a hanging immobile "curtain" for lower and upper lip defects, respectively. Alternatively, Karapandzic flaps can be used in selected patients for near total lip defects, the resultant microstomia improved by revisional lip balancing and tissue stretching. Using "extended" Karapandzic flaps that recruit adjacent cheek tissue along with remaining lip elements can also be used for some near total lip losses, providing a one-stage solution with some innervated tissue while minimizing microstomia. In practice, many of the techniques mentioned above are used in combination to achieve the best functional and esthetic results.