Synergistic Use of Local Flaps for Total Lower Lip Reconstruction

The loss of tissue in the lower lip has beentreated using different techniques dependingon the size and location (median or lateral) of thedefect.1,2 Plastic surgery for small defects of up totwo-thirds of the lower lip relies on surgicaltechniques such as direct suturing of the resectionmargins with or without Z-plasty. The methodsthat Gillies and Millard,3 Estlander,4 Abbe´,5 andKarapandzic6 proposed, as well as the staircasetechnique,7 have been used for reconstructionsinvolving up to two-thirds of the lip, whereas theproximity of the flaps is suitable for treatingcomplete lower lip losses, according to Von Bruns,8Bernard,9 and Bernard-Freeman-Fries.10–12The multiplicity of techniques reported in the literatureindicates that there is no ideal method fortotal lower lip reconstruction. It is generally agreedthat reconstruction after resection of more thantwo-thirds of the lower lip produces visible scarsand alters the kinetics of smiling.1,2,7The Sabattini-Abbe´ flap is a full-thickness one-lipflap that is pedicled on the superior or inferiorlabial vessels and rotated 180° to fit into the defectof the opposite lip. The Sabattini-Abbe´ flap can beused for reconstructing up to two-thirds of the lip.The staircase technique, used to close full-thicknessdefects of up to two-thirds of the lower lip, is basedon the advancement flap. Johanson and colleaguesfirst described it in 1974,13 and by Dado andAngelats,14 Stiernberg,15 Kuttenberger and Hardt16and Salgarelli and colleagues7 subsequentlymodified it. Reconstruction of the lower lip isperformed using a lateral advancement flap fromthe lateral parts of the lip and chin, in a stepwisefashion.7Here, we propose the synergistic use of thestaircase technique and a Sabattini-Abbe´ flap forreconstructions involving more than two-thirds ofthe lower lip (Figures 1A and B).