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Review | Journal Club

Local Flaps: Cheek and Lip Reconstruction

Jon-Paul Pepper, MD1; Shan R. Baker, MD1,2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
2Department of Otolaryngology–Head and Neck Surgery, Center for Facial Cosmetic Surgery, University of Michigan, Livonia
JAMA Facial Plast Surg. 2013;15(5):374-382. doi:10.1001/jamafacial.2013.1608.
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Importance  The reconstruction of cutaneous defects of the cheek and lip is a foundational topic for facial plastic and reconstructive surgeons. Facial defects have a significant impact on patient quality of life that has been well demonstrated.

Objective  To review new findings that have an impact on the planning and understanding of local flaps for the reconstruction of cutaneous defects of the cheek and upper lip; recent research in facial soft-tissue anatomy and vascular anatomy is integrated into a discussion of local flap reconstruction.

Evidence Review  A Medline search of scientific literature was conducted, with an emphasis on 1980 to the present. Search terms included cheek; lip; reconstruction; vascular anatomy, soft-tissue anatomy, aging face, outcomes, and perforator flap. Cadaveric studies were specifically sought for anatomic review, and comparison group outcome studies are preferentially cited over clinical case series.

Findings  Reconstruction of large medial defects of the cheek and upper lip is particularly challenging, and the V-Y subcutaneous tissue pedicle island advancement flap is valuable for repair of these defects. Outcomes analyses for local flap reconstruction are in high demand. Pedicled perforator flaps will likely see increased application for facial reconstruction in the near future.

Conclusion and Relevance  Detailed knowledge of the soft-tissue anatomy of the cheek and lip is critical to accurate surgical planning in local flap reconstruction.

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Figures

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Figure 1.
Soft-Tissue Anatomy of the Cheek
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Figure 2.
The Subunits of the Aging Midface Described by Mendelson and Jacobson5
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Figure 3.
Surface and Muscular Anatomy of the Lip
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Figure 4.
Vascular Anatomy of the Cheek and Lip
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Figure 5.
Transposition Flap

A, Design of a laterally based transposition flap for melanoma in situ of right buccal cheek aesthetic subunit. B, Defect closed. C, Eight-month postoperative photograph.

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Figure 6.
Bilateral Cutaneous Advancement Flaps

A, Bilateral advancement flaps for repair of a midline upper lip defect that involves the philtrum. Releasing incisions are made along the vermiliocutaneous border and nasal sill. An inferior W-plasty is performed to minimize the length of the standing cutaneous deformity. B, Defect closed.

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Figure 7.
V to Y Subcutaneous Tissue Pedicle Island Advancement Flap

A, Preoperative view of a large lateral upper lip cutaneous defect following Mohs microsurgical excision. B, Design of a V-Y subcutaneous tissue pedicle island advancement flap. Note that residual skin inferior to the defect at the vermiliocutaneous border and adjacent to the alar-facial sulcus is excised to create a more favorable subunit-based defect for inset. C, Oblique view of a V-Y subcutaneous tissue pedicle island advancement flap, showing a broad subcutaneous pedicle. D, Defect closed. E, Eighteen-month postoperative view, following scar revision.

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