Upper Lip Cancer with a Larger Lesion or Defect Requiring Reconstruction
When a tumour on the upper lip produces a lesion or surgical defect too large for simple closure, the reconstruction strategy must be carefully matched to the extent of tissue loss. The approach differs substantially depending on what proportion of the upper lip width is affected.
Clinical Scenario
This protocol applies to patients with cancer of the upper lip — not the lower lip — where the tumour or the resulting defect after excision is large enough to require formal reconstruction rather than primary closure alone.
Treatment Approach
Management centres on surgical excision with reconstruction selected according to defect size. Techniques range from wedge excisions and advancement flaps for smaller defects through to more complex flap procedures for defects involving a greater proportion of the lip.
The full reconstruction algorithm — including specific flap selection thresholds and the options for the most extensive defects — is detailed in the complete protocol.
References
DOI: 10.1017/S0022215116000499
- Similar to lower lip defects wedge excisions and advancement flaps can address upper lip defects which involve up to one half of the width of the upper lip.
- Defects of less than a third in the midline can be closed primarily.
- Defects involving greater than half of the lip can be reconstructed with cross-lip flaps from the lower lip.
- Peri-alar crescentic advancement flaps can be used to disguise the advancement of the upper lip when the advancement encroaches to the medial part of the nose.
- For defects involving more than two-thirds of the lip, a Burow-Diffenbach reconstruction can be performed.
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