This chapter outlines an approach to Lip reconstruction based on fundamental awareness about the anatomy, physiology, functional as well as aesthetic significance of the lips and oral commissure.
A very large variety of lip defects exist, and approach to reconstruction depends upon the size and complexity of every defect.
Owing to the highly specialized nature of lip tissues, small to moderate-sized defects are typically repaired by lip tissue itself in order to restore circumferential vermillion and oral competence. The ‘lip for lip’ dictum must be adhered to wherever possible and practicable, without producing any significant micro-commissure. The Estlander flap is frequently employed for lateral defects, the size, design and execution of the flap being governed by the precise nature of the defect.
A highly versatile method is the Karapandzie technique; in which neurotized and vascularized lip tissue is moved to achieve the most important objectives of lip reconstruction, namely oral competence and circumferential vermillion. The main limitation to this technique is the final commissure diameter achieved, as it is most important to avoid micro-commissure.
Other less frequently used techniques are touched upon with examples.
For large lining defects of the lower lip, the FAMM (Facial Artery Myo-Mucosal) flap can be successfully deployed, and is illustrated.
Once the defect exceeds critical dimensions, there is need to introduce tissues from elsewhere. For total lower lip defects, the folded FRAFF (Free Radial Artery Forearm Flap) and folded ALT (Antero-lateral thigh) flaps may be employed, along with a circum-oral sling to facilitate competence. Both techniques are demonstrated.
For extensive commissural defects involving both upper and lower lips, we have used split fascio-cutaneous flaps with slings to restore a competent mouth. This is clearly demonstrated.
Almost the entire spectrum of lip defects is covered with detailed intra and post-operative pictures to demonstrate the wide variety of issues and possible solutions.