Evolving concepts in lip reconstruction.

An extensive review of world literature reveals that current innumerable procedures to repair upper and lower lip defects were already devised about the middle of the nineteenth century. There is little that can be defined as original after that time. In fact, most of the so-called new methods for labial reconstruction are a modification of old ideas. In tracing the steps of evolution in lip repair, the authors emphasize that only few concepts should be regarded as decisive to achieve a good final result. The use of lip tissue to repair lip defects should be one of the aims of modern cheiloplasty. Following this principle, it is possible to reestablish interrupted sphincteric functions of the orbicularis oris and, at the same time, most of the expression of emotions. When insufficient material is available for reconstruction, full-thickness local flaps of cheek can be considered the alternative solution, far better than distant lined flaps, which create a static, unaesthetic barrier.