LIPS RECONSTRUCTION AND THE PERIORAL REGION
Lip reconstruction has significant aesthetic and functional implications.
Attention to cosmetic subunits, as well as important landmarks such as the white line, is of paramount importance.
Linear and wedge repairs are generally most straightforward, though larger defects benefit from a variety of flap approaches.
Small defects on the upper and lower cutaneous lip may be repaired in a linear fashion; aim to orient closures along existing creases if possible.
Advancement flaps are frequently performed for mid-size defects on the upper cutaneous lip; incise parallel to and 1 mm from the vermilion border for ideal camouflage.
While island pedicle flaps have a reputation for undesirable scarring, this can be largely obviated by judicious undermining and meticulous suturing.
If the nasolabial fold is blunted, Z-plasty can be considered approximately 6 months postoperatively.
Partial closures may be useful in select patients, particularly those reluctant to undergo larger procedures.
Pitfalls and Cautions
The white line in younger patients is very pronounced; deviation of less than 1 mm may still yield a cosmetically obvious mismatch.
Larger lip reconstructions, such as the Karapandzic flap, must be performed precisely to avoid disastrous outcomes.
Patient Education Points
Always gauge a patient’s willingness to undergo and recover from an extensive procedure before it is initiated.
Some patients may prefer a small partial closure to a more involved and much larger flap.
Patients should be warned against opening their mouths wide, eating fruit such as apples, and other activities that stretch the orbicularis oris in the immediate postoperative period.
Most flaps on the lips are coded with 14060 or 14061, and these codes include the excisional component; it is not appropriate to bill both an excision and a flap repair code simultaneously, except for Mohs excision codes.
When coding a flap, graft, or linear repair, medical necessity is the ultimate arbiter of appropriateness.
The lips and perioral region represent a critical region both aesthetically and functionally. They are central to facial expression, are sensory organs for food and personal contact, and provide oral competence at rest and during mastication. The lips also have rich vasculature and sensory innervation.
The perioral region is bounded by the nasolabial folds laterally and superiorly, and by the mental crease of the chin inferiorly. The lips are suspended only by muscles and the fibrous tissues of the modiolus at each oral commissure. Therefore, the lips and the oral commissures represent mobile free margins. Reconstruction of the perioral region requires meticulous planning to direct tension in appropriate vectors. Retraction of the upper lip ...