Reconstruction of a Large Upper Lip Defect with Severe Associated Injuries by the Combination of the Kazanjian and Abbé Flaps

Upper lip defects caused by animal bites can result in serious oral and facial functional compromise. The management of such large defects in a way that an optimal functional and cosmetic outcome is reached remains a major reconstructive challenge. We present the upper lip reconstrucion of a 57-year-old woman who was attacked by her dog. The attack caused severe scalp and facial injuries, including a large upper lip defect. After initial trauma treatment, the lip defect was reconstructed by the combination of the Kazanjian and Abbé flaps. No venous circulation defect, wound healing problems or other complications were detected. After three months, sensory function of the area returned, and after 6 months the movements of the lip were satisfactory, the patient was able to pucker the lips, open the mouth and to eat. Beyond that, a cosmetically acceptable outcome was reached, so that the psychosocial reintegration of the patient was not at risk.We propose that combination of the Kazanjian and Abbé flaps offers an excellent alternative for the reconstruction of wide or total lip resections. *Corresponding author: Gabor Braunitzer, Faculty of Dentistry, Department of Oral Surgery, University of Szeged, 6720 Szeged, Tisza Lajos krt. 64, Hungary, Tel: +36 62 545 283; Fax: +36 62 545 282; E-mail: [email protected] Received March 26, 2013; Accepted May 30, 2013; Published June 07, 2013 Citation: Varga J, Pinter S, Antal M, Varga A, Kemeny L, et al. (2013) Reconstruction of a Large Upper Lip Defect with Severe Associated Injuries by the Combination of the Kazanjian and Abbé Flaps. Surgery Curr Res 3: 132. doi:10.4172/21611076.1000132 Copyright: © 2013 Varga J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Defects of the lips and the perioral area result mostly from malignancies, birth defects or trauma. Upper lip defects caused by dog bites can result in serious functional compromise in terms of oral competence, facial expression, speech, diet, dentureand cutlery use, and sensation. The management of large defects remains a significant reconstructive challenge, requiring meticulous preoperative planning and surgical technique to optimize the functional and cosmetic outcome. The upper lip presents a uniquely complex problem for the facial plastic surgeon because of its prominent location, elegant form, and important functions. The main goals of reconstruction remain the restoration of oral competence, the maintenance of oral opening, and the restoration of normal anatomic relations so that both the active (smile) and passive (form) cosmetic outcome is acceptable. Small, full-thickness defects involving approximately one fourth to one third of the lip can usually managed by primary closure. The width of such defects is usually less than 2 cm [1,2]. Whenever possible, local tissue should be used to minimize donor site morbidity and for the best overall tissue color and texture match [2,3]. In some cases the size of the defect makes it necessary to use myocutaneous or free flap by microvascular technique. If the defect involves 1/3 2/3 of the lip, it can be managed by a cross-lip flap, like Abbé or Estlander [1,4], circular rotational flap, such as Karapandzic or Gillies [1,5], nasolabial flap [6] or the Kazanjian reverse flap [7]. In the case of larger defects, a complete reconstruction poses a major challenge. If about 75% of the remaining lip is intact, reconstruction can be attempted by using tissue from the remaining lip. For multistep reconstructive procedures, combined local flaps are used. The initial reconstruction, such as an expanded Karapandzic flap will restore the oral sphincter [1,8,9]. Subsequently, the cross-lip flap can be used to restore symmetry and volume [8]. The modified version of this method, the bilobed flap supplemented by a Karapandzic flap has been used to reconstruct lower lip defects at a success rate over 80% [1,3]. Distant free flaps using microvascular techniques can also be used as well as advancement myocutaneous flaps. The most commonly used free tissue transfer is the free radial forearm flap, which is frequently used with the tendon of the long palmar muscle to support the lip [1,10]. This is an innervated flap, as the nerve within the flap (the lateral antebrachial cutaneous nerve) can be reconnected to the mental nerve or to the inferior alveolar nerve. This is a suitable method to repair total or near total lip defects. Other free flaps, such as a gracilis muscle free flap [10] or a free temporal scalp flap can also be used [11]. Here we report a case with a large lip defect and extremely serious associated injuries due to a dog attack, and the process of reparation by a combination of carefully selected methods.