Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Microsurgery. 2024 Oct;44(7):e31242. doi: 10.1002/micr.31242.
Near-total to total lower lip defects present significant challenges for reconstructive surgeons, requiring restoration of oral competency, maximization of oral aperture, and cosmetic appearance. This report explores a novel reconstructive option addressing all three needs. Traditionally, local flap options restore cosmesis and oral competency by recruiting local tissue of similar thickness, pliability, and appearance, but often result in microstomia. Conversely, free flaps prevent microstomia but can lead to bulky and cosmetically unacceptable reconstructions. We present the first case of using a super-thin superficial circumflex iliac artery perforator (SCIP) free flap for near-total, full-thickness lower lip reconstruction. The patient was a 66-year-old female with recurrent squamous cell carcinoma of the lower lip, requiring wide local excision and resulting in an 80% full-thickness defect with unilateral oral commissure loss. An 8 cm × 5 cm × 5 mm SCIP flap was raised with a 4.5-cm pedicle length and anastomosed to the facial artery and vein. Clear fluids were commenced 7 days postoperatively, wounds healed 2 weeks postoperatively, and a normal diet was resumed at this time. The SCIP flap offers an excellent additional option for managing full-thickness near-total to total lower lip defects. Its thin, pliable nature and minimal donor site morbidity help restore oral competency, maximize oral aperture, and achieve a pleasing cosmetic result.
下嘴唇近全层和全层缺损给修复外科医生带来了巨大挑战，需要恢复口腔功能、最大限度地扩大口腔开口和改善美观。本报告探讨了一种新的重建方法，可满足所有这三个需求。传统上，局部皮瓣通过招募具有相似厚度、柔韧性和外观的局部组织来恢复美容和口腔功能，但往往导致小口畸形。相反，游离皮瓣可以避免小口畸形，但可能导致体积过大和美容效果不佳的重建。我们首次报告了使用超薄旋髂浅动脉穿支（SCIP）游离皮瓣进行下嘴唇近全层、全层重建的病例。患者为 66 岁女性，患有复发性下唇鳞状细胞癌，需要广泛局部切除，导致 80%全层缺损和单侧口角丧失。采用 8cm×5cm×5mm 的 SCIP 皮瓣，蒂长 4.5cm，并与面动脉和静脉吻合。术后 7 天开始进流食，术后 2 周伤口愈合，此时恢复正常饮食。SCIP 皮瓣为全层近全层和全层下嘴唇缺损的处理提供了极好的额外选择。其薄而柔韧的特性和最小的供区并发症有助于恢复口腔功能、最大限度地扩大口腔开口，并获得满意的美容效果。
