Lip reconstruction with the musculocutaneous nasolabial flap following lip resection achieves good functional and aesthetic outcomes, research suggests.
Seng-Feng Jeng (I-Shou University, Kaohsiung, Taiwan) and team say that their postoperative analysis of 21 lip reconstruction cases demonstrated that, in the absence of any extensive defects that may require a free-tissue transfer, the nasolabial flap is the preferred local flap for lip reconstruction.
The authors say that using the nasolabial flap, which involves a single-stage procedure and prevents microstomia and distortion of the commissure, provides benefits over other lip-reconstruction procedures such as the Karapandzic technique, which results in distortion of the commissure.
All 21 patients in the study underwent a one-stage nasolabial musculocutaneous flap reconstruction for lip defects, and none required a second stage for flap division and insert. In all patients, reconstruction of the lips involved preserving the modiolus face at the mouth angle and the de-epithelizing and subcutaneously tunneling the nasolabial flap. There were no cases of microstomia, the researchers note.
Electromyographic activity was detected in 10 of the 14 flaps assessed. Oral competency, assessed in 18 patients using the Drooling Rating Scale, was well-preserved. Indeed, two-thirds of the patients had no drooling or mild drooling problems, five patients had moderately severe drooling, while one patient experienced severe drooling.
Aesthetic outcomes, which were analyzed postoperatively over a follow-up period of 6 months to 5 years using the Patient and Observer Scar Assessment Scale in 16 patients, showed that all aesthetic outcomes were successful. Using observer's agreement, most patients achieved a score of 3 or less, indicating scars that almost resembled normal skin.
The authors say that patients' assessments of their own scar outcomes were also "promising." Only two patients felt that their scar could have looked better, while all other patients were satisfied with their aesthetic outcome.
"Our results revealed that most observers and patients alike felt their resultant lip scars were close to their normal surrounding skin," remark Jeng and team in the Journal of Plastic, Reconstructive and Aesthetic Surgery.
They stress that oral competency remains the most important aim after lip reconstruction and point out that their findings showed that the majority of patients in their study who underwent nasolabial musculocutaneous flap reconstruction preserved their oral competency, as demonstrated by their drooling scores.
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