Gonzalez Abel, Etchichury Dardo
From the Instituto Oncología Angel H. Roffo, Buenos Aires, Argentina.
Ann Plast Surg. 2018 Oct;81(4):433-437. doi: 10.1097/SAP.0000000000001521.
Lower lip reconstruction should restore oral competence, speech, and cosmesis. These goals are a challenge when reparing large lower lip defects. Karapandzic flap is a reliable technique with consistent functional and esthetic outcome. In large defects, it might result in disproportion between the upper and lower lips and blunting of the commissures. The Abbe flap is useful as a lip balancing procedure and avoids the rounding of the commissures.
Five cases of lower lip skin cancer treated with Mohs surgery with defects up to 80% were reconstructed with a combination of Karapandzic and Abbe flaps. All cases were performed under local anesthesia.
We observed no complications related to wound or flap survival. All patients preserved function. Esthetic outcome was considered very good to excellent in 4 cases and good in 1. Mild micrsotomy wad observed in 1 patient.
We believe that the standard Karapandzic and Abbe flap compares favorably with the modified Abbe plus modified Karapandzic flap combination in defects up to 80% because it is performed straightforward and can be done under local anethesia. Similarly, when compared with Karapanzic plus Burrow-Bernard-Webster combination in defects up to 80%, we believe that the standard Karapandzic and Abbe flaps are better both in function and in esthetics. In defects larger than 80%, both flap combinations are better than standard Karapandzic and Abbe flaps because of the risk of microstomy.
下唇重建应恢复口腔功能、言语功能和美观。修复大面积下唇缺损时，这些目标颇具挑战。卡拉潘齐克皮瓣是一种可靠的技术，功能和美学效果一致。对于大面积缺损，它可能导致上下唇比例失调和口角变钝。阿贝皮瓣作为一种唇部平衡手术很有用，可避免口角变圆。
5例经莫氏手术治疗的下唇皮肤癌患者，缺损达80%，采用卡拉潘齐克皮瓣和阿贝皮瓣联合修复。所有病例均在局部麻醉下进行。
我们未观察到与伤口或皮瓣存活相关的并发症。所有患者均保留了功能。4例患者的美学效果被认为非常好至优秀，1例为良好。1例患者出现轻度显微缝合问题。
我们认为，在缺损达80%的情况下，标准的卡拉潘齐克皮瓣和阿贝皮瓣与改良阿贝皮瓣加改良卡拉潘齐克皮瓣联合术相比具有优势，因为它操作简单，可在局部麻醉下完成。同样，与卡拉潘齐克皮瓣加伯罗-伯纳德-韦伯斯特联合术相比，在缺损达80%的情况下，我们认为标准的卡拉潘齐克皮瓣和阿贝皮瓣在功能和美学方面都更好。在缺损大于80%的情况下，由于存在显微缝合的风险，两种皮瓣联合术都比标准的卡拉潘齐克皮瓣和阿贝皮瓣更好。
