Lip Surgery - Surgical Indications

The most common reason for creation of a lip defect is to remove a lip cancer.  Cancers of the lower lip are most common and most often caused by sun exposure.  Although, tobacco use has also been implicated in their formation.  Cancers of the upper lip are less common but are more aggressive and more likely to metastasize or spread. 

Two types of surgeries are used to reconstruct the lip.  Both of these methods result in a decrease in the circumference of the mouth.   If the defect is less than 1/3 of the lip it can usually be reconstructed by removing a "V" shaped wedge from the lip and closing the lip primarily.  Defects between 1/3 to 2/3 of the lip can be reconstructed in two stages using an Abbe Estlander Flap.  This flap takes a portion of the intact lip (equal to 1/2 the length of the defect) and rotates this tissue into the defect.  After the final stage, the patient's upper and lower lip are of equal length but the oral circumference is reduced. 
 View Flap Technique   

    
Lip Surgery - Post Operative Care

All incisions should be kept clean.  Antibiotic ointment should be applied three times a day and after 24 hours the wound may be washed.  The skin should not be hit, stretched or exposed to cold or direct sunlight. 

Lip Surgery - Surgical Technique-"V" Resection for Squamous Cell Carcinoma  ("V" resection of the ear)
 

• The patient has a small squamous cell carcinoma of the lower lip.
• A "V" shaped resection is outlined to resect the cancer. The tip of the "V" does not cross the skin crease between the lip and the chin. If a "V" is not resected the defect cannot be closed without creating a significant deformity.
• Both sides of the lower lip are grabbed on the upper portion to provide retraction and pressure to occlude the inferior labial artery. Using a #11 blade a through and through cut is made in the inferior portion of the planned incision and carried superiorly.
• The left side of the inferior labial artery is cauterized to control bleeding. An Alice Clamp grabs the specimen at a point away from the cancer. The clamp is used to retract the specimen and the final cut is made using a #11 blade.
• The right portion of the inferior labial artery is cauterized
• A 3-0 Chromic stitch is used to close the lower portion of the muscle layer.
• A 3-0 Chromic stitch is used to close the lower portion of oral mucosa.
• The middle and upper portions of the muscle layer is closed with a 3-0 Chromic stitch.
• The most important stitch is the placement of a 5-0 Nylon stitch to align the vermillion-cutaneous junction.
• The skin is closed with an interrupted 5-0 Nylon Stitch.
• Final appearance of the skin closure.
• The upper oral mucosa is closed with a 3-0 Chromic stitch and the outer labial mucosa is closed with a 5-0 Nylon Stitch.
• Appearance of the final lip closure.
• Appearance of the lip three months after surgery.

Lip Surgery - Surgical Technique - Abbe-Estlander Flap: 
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