Stepladder Skin-Muscle-Mucosal Flap for Lower Lip Reconstruction
A. D. PELLY
E.-P. TAN
It is generally accepted that the orbicularis oris should be reconstructed following major resections of the lower lip. Many methods involving full-thickness flaps from the upper lip are likely to produce further functional disruptions of the circumoral sphincter. Dissatisfaction with these methods of repair led surgeons to develop alternative techniques (1, 2, 3).
INDICATIONS
We present a technique of lower lip repair that allows adequate excision of the primary lesion, respects the functional integrity of the upper lip, and permits reconstruction of the circumoral sphincter in the same operation (4). This technique has been used without complication in reconstruction of defects of half the lower lip extending to the commissure (Figs. 166.1 and 166.2). The technique has been extended to restore the oral sphincter following damage to the ramus mandibularis of the facial nerve.
OPERATIVE TECHNIQUE
The extent of a full-thickness excision of the lip is outlined along with a stepladder incision over the right side of the lower lip (Fig. 166.1A). The lesion is excised, and the right lower lip is advanced by the stepladder technique (Fig. 166.1B). A prophylactic vermilionectomy is carried out on the remainder of the right lower lip.
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