Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
CORRESPONDENCE  
Year : 2022  |  Volume : 15  |  Issue : 2  |  Page : 207-208
Repair of a large upper lip and malar defect


Department of Dermatology, Hospital Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil

Click here for correspondence address and email

Date of Web Publication21-Jul-2022
 

How to cite this article:
Domingues AA, Belalcazar ES, Dupont L, Cafrune FE. Repair of a large upper lip and malar defect. J Cutan Aesthet Surg 2022;15:207-8

How to cite this URL:
Domingues AA, Belalcazar ES, Dupont L, Cafrune FE. Repair of a large upper lip and malar defect. J Cutan Aesthet Surg [serial online] 2022 [cited 2022 Aug 9];15:207-8. Available from: https://www.jcasonline.com/text.asp?2022/15/2/207/351501





   Introduction Top


We describe a case in which the patient had undergone three previous conventional surgeries, with compromised margins, and already presented a distortion on the right side of the upper lip. For the reconstruction of this extensive defect, we propose an adequate alternative carried out in a single surgery and providing good aesthetic and functional results.


   Case Report Top


A 69-year-old woman with micronodular basal cell carcinoma, located in the right nasolabial fold, after a history of three previous conventional surgeries resulting in compromised margins presented with retraction of the upper lip and a scar lesion in the right nasolabial fold, with a hardened region. Mohs micrographic surgery was performed in two stages with a final defect of 5.5 cm × 2.5 cm [Figure 1].
Figure 1: Surgical defect involving malar and perioral region, measuring 5.5 cm × 2.5 cm

Click here to view


Due to the extensive final defect, at the end of two stages in the two-stage Mohs micrographic surgery, we needed to bring tissue from an area with tissue reserve that would make the direction of the tension vectors parallel to the lip opening, thus avoiding further distortion.

We opted for a finger-shaped transposition flap, which consisted of tissue from the preauricular/mandibular region transposing the malar region, with a rotation movement, and filling the extensive defect that affected the malar and perioral region. The donor area was marked with the same dimensions as the recipient area, the length being drawn in such a way as to avoid tension after the arc rotation of a pivot based on the mandibular region. The angle of rotation was approximately 90°, with subcutaneous oral fat preserving branches of the facial artery [Figure 2]. After flap positioning, sutures were performed in 2 planes, using monocryl 4.0 for the subcutaneous tissue and nylon 5.0 for the superficial portion. At 4-month follow-up, the patient was satisfied with the postoperative evolution [Figure 3] and [Figure 4].
Figure 2: Transposition flap movement in a finger shaped closure

Click here to view
Figure 3: Result after 4 months (side view)

Click here to view
Figure 4: Result after 4 months (front view)

Click here to view



   Discussion Top


The transposition flap is an excellent option when there is a risk of functional and aesthetic impairment of the surgical defect if it is repaired by primary closure, skin graft, or secondary intention.[1]

By definition, the transposition flap must be elevated over a central area of normal skin to reach its final destination for the closure of the primary defect.[2] It is commonly used to repair skin defects in the head and neck regions. They have the advantage of being able to move a tissue reserve, redistributing the stress vectors to more favorable directions, leading the tension away from the primary defect. This is useful for repairing injuries that, if closed otherwise, could cause high levels of tension or distortion of anatomical structures.[1],[2],[3]

In the case described, the patient’s lip distortion was due to the three previous surgeries with compromised margins. We opted for a transposition flap to reestablish tissue volume with skin from an area with greater reserve. The preauricular and mandibular region is a good option in these cases, also to avoid any additional scars in the central area of the face, as would happen with a bilobed flap of the malar region. The major final surgical defect was repaired with a unilobed finger-flap that redirected the tension from the perioral region to the mandibular region. It is important to note that due to the length of the flap, it is necessary to leave an adequate thickness of subcutaneous tissue (axial and perforating vessels) to allow for distal nutrition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
   References Top

1.
Bednarek RS, Sequeira Campos M, Hohman MH, Ramsey ML Transposition flaps. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.  Back to cited text no. 1
    
2.
Blake BP, Simonetta CJ, Maher IA Transposition flaps: Principles and locations. Dermatol Surg 2015;41:S255-64.  Back to cited text no. 2
    
3.
Rohrer TE, Bhatia A Transposition flaps in cutaneous surgery. Dermatol Surg 2005;31:1014-23.  Back to cited text no. 3
    

Top
Correspondence Address:
Aline Alves Domingues
Department of Dermatology, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Santa Cecília 1518/304, Porto Alegre, RS 90020-090
Brazil
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCAS.JCAS_170_21

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed164    
    Printed2    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal