The labio-mandibular flap for upper lip and peri- commissural defects

Aim: Peri-commisural defect reconstruction using the Abbe or Estlander flaps tend to pilfer tissue from the lower lip, contributing to microstomia, with its attendant problems. In this study, we aim to design a flap for more superficial defects, in which the underlying orbicularis oris muscle can be preserved when resecting peri-commisural skin malignancies whilst also ensuring completeness of excision. Methods: In a retrospective case review of 7 cases at our institution over a 12-month period (20162017), we conceptually designed a perforator-plus fascio-cutaneous flap from within the labiomandibular fold with a 6-month follow-up in terms of oncological clearance and aesthetic outcome. The cohort was composed of patients with skin cancers e.g. basal and squamous cell carcinomas, presenting to a tertiary care facial plastic surgery centre. The technique involved raising a flap from within the peri-oral area, with a scar disguised along the labio-mandibular and naso-labial folds which allows for both an aesthetic reconstruction and the preservation of the oral sphincter mechanism, by avoiding microstomia. The outcomes measured were (1) to ascertain whether this procedure is oncologically safe, (2) there were instances of microstomia and (3) aesthetic appearance. Results: All oncological lesions were completely excised in all cases and at up to six months’ followup, there were no instances of recurrence. Functionally, oral sphincter function was preserved in all instances as was aesthetic appearance. Conclusion: The labio-mandibular flap is an oncologically safe procedure for skin cancers whilst preserving oral sphincter function and maintaining aesthetics. It is hence, a superior alternative to Abbe and Estlander flaps, for more superficial defects, not requiring mucosal excision.