Reconstruction Of Large Lower Lip Defect Using A V-Y Advanced Musculocutaneous Flap Combined With A Musculomucosal Stacked Flap

Background:The lips play an important role in facial aesthetics and perform various basic functions such as articulation,mastication and facial expression.Lower lip defects are mostly caused by tumor resection and trauma,which not only affect the aesthetics,but more importantly,the functions that are closely related to our life can be greatly affected.Therefore,the repair of lower lip defect should not only restore the appearance,but also consider the reconstruction of lower lip function to reduce the inconvenience of patients’ daily life,improve the quality of life and increase self-confidence.The repair of large total lower lip defects remains a challenging task.Purpose:To describe a method to repair a large lower lip defect including vermilion using local musculocutaneous flaps combined with musculomucosal stacked flaps Patients and methods:From 2020 to 2022,a total of 8 patients with lower lip defect that was larger than 2/3 of the lower lip were recruited in this retrospective study;the patients included three men(37.5%)and five women(62.5%),the age ranged from 22 to 88 years(average 56.9 years).The size of the lip defect ranged from 2/3 of the lower lip to the full length of the lower lip,all were located in the middle of the lower lip,had a mucosal residual height of >1cm,and did not involve the corners of the mouth.All of these patients underwent V-Y advancement musculocutaneous flap combined with musculomucosal stacking flap surgery.The reconstruction included 2layers.To increase the height of the outer tissue such as the skin,a V-Y advancement of the musculocutaneous flap in the buccal area is required.The longitudinal height of the mucosa is then increased by stacking the musculo-mucosal flaps and a new lipstick red is formed.The follow-up focuses on the long-term functions and cosmetic results.Results:All the patients with lower lip defects were repaired with this technique.All the flaps survived well except 1 case with minor necrosis of mucosa which healed well after debridement and suture.During a followup of 6 to 12 months,after data analysis showed preoperative and postoperative scores p < 0.05,with a significant difference before and after treatment.All patients were satisfied with the cosmetic and functional results of the one-stage reconstruction of the lower lip.Conclusion:The combination of a V-Y advanced musculocutaneous flap and musculomucosal stacked flaps is a relatively simple and effective method to repair a large lower lip defect including vermilion.It can meet the requirements of both cosmetic and functional reconstruction at the same time.This method is a safe option with high flap survival rate.