Nasolabial flap shows promise for lip reconstruction
By Afsaneh Gray, medwireNews Reporter
12 March 2013
J Plast Reconstr Aesthet Surg 2013; 66: 352–357

medwireNews: Using the musculocutaneous nasolabial flap for lip reconstruction gives good functional and cosmetic results, a study shows.

The study reports on the results of 21 patients with lip defects who received the surgery between 2005 and 2010. All patients successfully underwent the procedure in one stage, with no subsequent flap failures.

"In the absence of any extensive defects that may require a free tissue transfer, we consider the nasolabial flap to be the preferred local flap for lip reconstruction," comment lead researcher Seng-Feng Jeng (I-Shou University, Kaohsiung, Taiwan) and co-workers.

The surgery involved the removal of the epithelium of the nasolabial flap, which was then tunneled subcutaneously in order to reconstruct the new lip.

Inferiorly based musculocutaneous nasolabial flaps were used for all patients, with unilateral flaps used for defects that were up to 70% in size and bilateral flaps used for those that were larger than 70%. Before the operation, the presence of the angular artery was confirmed using hand-held Doppler.

Writing in the Journal ofPlastic, Reconstructive and Aesthetic Surgery, the authors suggest that musculocutaneous tissue is preferable to subcutaneous tissue not only because of its blood supply, but also because of its bulkier nature, which they believe increases oral competency.

Postoperative electromyograms were conducted on 14 flaps, with 10 showing detectable activity, suggestive of re-innervation. Nonetheless, the authors caution that, "whether re-innervation of these musculocutaneous flaps will allow the muscles to become functional, or remain simply as a static sling, is still in question."

Patients were also assessed with the Drooling Rating Scale, a questionnaire designed to measure the functional quality of the reconstruction. Only one patient suffered from severe drooling, with two-thirds of patients reporting no drooling or only mild drooling.

All patients were able to eat a normal diet and none developed microstomia.

To assess cosmetic results, the Patient and Observer Scar Assessment Scale (POSAS) was used. The POSAS is a questionnaire that consists of two numeric scales, one to be completed by the patient and one by observers.

In the 16 patients to whom the POSAS was administered, the observers gave the scars a score of 3 or less, indicating that they almost looked like normal skin. Fourteen patients were also satisfied with the esthetic outcome, with only two feeling that their scar could have been better.

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