Technical tips in reconstruction of the upper lip with the Abbe flap

NYU Langone Medical Center, New York, New York, United States
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 08/2008; 122(1):240-3. DOI: 10.1097/PRS.0b013e31817740f7
Source: PubMed
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    ABSTRACT: The upper lip can be divided into aesthetic subunits. Accordingly, we classified the upper lip defect into 3 categories: medial subunit defect, lateral subunit defect, and cross-subunit defect. The defect should be repaired aesthetically. We developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers. The flap was more flexible for aesthetic reconstruction of the upper lip, even the fine anatomic structures.
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    ABSTRACT: In Anbetracht ihrer stetigen Zunahme ist der Hals-Nasen-Ohren-Arzt mehr und mehr in die Frühdiagnostik und Therapie von Hauttumoren des Gesichts eingebunden. Prominente sonnenexponierte Zonen wie Nase, Stirn, Wange und Ohrmuschel sind am häufigsten betroffen, aktinische Keratose und Basalzellkarzinom die häufigsten Diagnosen. Chirurgische Tumorentfernung und Defektdeckung orientieren sich an der Histologie sowie den anatomischen Besonderheiten und respektieren v.a. Dicke und Verschieblichkeit der benachbarten Haut. Generell werden kleine bis mittelgroße Defekte in Regionen gut verschlieblicher Haut mittels einfacher Naht oder Dehnungsplastik verschlossen. Größere Defekte oder Problemzonen betreffende Tumoren erfordern spezielle Techniken der Defektdeckung unter Zuhilfenahme verschiedener gestielter Lappenplastiken oder freier Transplantate. Die Entfernung ausgedehnter Tumoren macht mitunter rekonstruktive Eingriffe an N.facialis, Ductus parotideus und Ductus lacrimalis erforderlich. Gleiches gilt für die Gerüststrukturen von Augenlid, Nase und Ohrmuschel. As the incidence of facial skin tumors is rising, otorhinolaryngologists are becoming more and more involved in the field of facial plastic surgery. The most common tumor locations on the head are the sun-exposed areas such as the nose, forehead, cheek, and auricle. The most common histologic findings are actinic keratosis and basal cell carcinoma. In planning tumor resection and defect repair, many factors, including histology, size, and localization of the tumor as well as conditions of the adjacent skin, must be considered. The key to defect repair after tumor resection is to choose the most appropriate technique from a range of possibilities. Because of skin laxity, most small and midsize facial defects can be closed directly or with high-tension sutures under skin expansion. More extensive defects and those located in critical areas require pedicled flaps or free grafts transferring skin from adjacent or distant areas. In patients with recurrent or deeply infiltrative tumors, reconstructive procedures of the facial nerve, parotid duct, and lacrimal duct might be needed. This is also true for reconstruction of the anatomic framework of the eyelids, the nose, and the pinna.
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    ABSTRACT: BACKGROUND: Desmoplastic trichoepithelioma (DT) is a benign appendageal tumour predominately localized on the facial skin. The histological diagnosis can be difficult in some cases. Partial malignant transformation of a DT is a rarity and a complete transformation has never been described in literature. CASE REPORT: A DT of the upper lip was diagnosed histologically by a small biopsy 4 years previously. At presentation, the tumour had enlarged and had partly infiltrated the left side of the upper lip and subnasal region. Histological evaluation confirmed a microcystic adnexal carcinoma but without evidence of malignant transformation of the DT. It appeared that a too-small initial biopsy had led to the incorrect histological diagnosis of a benign tumour. Thus, it was necessary to perform a tumour resection and reconstruction using a two-flap technique including a rotation flap and an Abbé flap. Functional and aesthetic outcomes were good after 6 months. There were no recurrences during a 12-month follow-up. CONCLUSION: A facial DT should be resected completely. Patients should be attended for follow-ups, keeping in mind the difficulty of making a proper histological diagnosis from small biopsies or excisions and the consequences of ablative facial surgery. However, in particular cases, subtotal defects of the upper lip region are amenable to reconstruction without gross functional or aesthetic deficits.
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