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a smoker since the age of 20&#44; presented with a tumor on the right lower lip of 6 months&#8217; duration&#46; He reported no bleeding&#44; although he had felt increased pain in the last few weeks&#46; Physical examination revealed a tumor 2<span class="elsevierStyleHsp" style=""></span>cm in diameter at the largest point&#46; The tumor was papilliform&#44; hyperkeratotic&#44; and had spread to the buccal mucosa at the labial commissure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The incision to remove the tumor included the full thickness of the skin and adequate margins &#40;1<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; The wound was then closed with a Karapandzic flap combined with a contralateral sliding flap&#46; The plane of dissection extended to the muscle&#44; and efforts were made to preserve the shape and function of the mouth&#46; The procedure was performed under general anesthesia and a local anesthetic &#40;2&#37; mepivacaine&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the early postoperative outcome&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The principal aim of oncologic surgery is to remove the lesion with tumor-free margins&#46; The choice of reconstructive technique depends on the anatomical region involved&#44; the depth and size of the tumor&#44; the characteristics of adjacent tissue&#44; and the surgeon&#39;s skill&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> If direct closure cannot be used because the defect is large and excessive tension would compromise function and aesthetics&#44; the surgeon&#39;s second choice would be to use flaps&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is no ideal method for lip reconstruction that avoids alterations of form or function such as microstomia or an incompetent oral commissure&#44; which is associated with chronic drooling if there is suspension&#46; If the lesion occupies more than a third of the lip&#44; flaps are usually used to reconstruct these defects&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The combination of a Karapandzic flap and a contralateral sliding flap provided several important advantages in this case&#58; the technique could be completed in a single procedure&#59; once the surgeon learns the technique it is accomplished quickly&#59; and an important network of vessels and nerves are preserved&#44; ensuring long-term safety with good movement and sensitivity&#46; Moreover&#44; this combination reduces the upper extension of the Karapandzic flap&#44; thus avoiding damage to vessels and nerves &#40;eg&#44; the terminal mandibular and buccal branches of the facial nerve&#41; that are sometimes associated with this flap&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The technique consists of excising the tumor and then cutting myocutaneous flaps&#44; dissecting the orbicularis oris muscle to locate the arterial and venous branches of the facial vessels while attempting to avoid the nerve branches&#46; The skin and muscle tissue can then slide forward&#44; leaving the underlying muscle intact&#46; These flaps are highly mobile and can be rotated toward the defect without constricting the vessels&#46; Care should be taken to control bleeding before suturing the wound&#46; The mucosal tissue and the muscle plane are first closed with absorbable sutures&#46; Nonabsorbable sutures are then used to close the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Other techniques&#44; such as the V-block or the Estlander flap can cause functional complications and large defects&#46; They are also more likely to lead to microstomia&#46; The Gillies flap technique&#44; which is even more invasive and leads to more complications&#44; can be avoided when the surgical wound is to one side of the lip&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Closure of Large Lower Lip Defects: Combining a Karapandzic Flap and a Contralateral Sliding Flap
Cierre de grandes defectos en el labio inferior. Combinación: colgajo de Karapandzic y colgajo de deslizamiento contralateral
I. Pérez-López
Autor para correspondencia
ipl_elmadrono@hotmail.com

Corresponding author.
, A. Martínez-López, J.C. Ruiz-Carrascosa, R. Ruiz-Villaverde
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica, Complejo Hospitalario Universitario de Granada, Granada, España
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    "titulo" => "Closure of Large Lower Lip Defects&#58; Combining a Karapandzic Flap and a Contralateral Sliding Flap"
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      "es" => array:1 [
        "titulo" => "Cierre de grandes defectos en el labio inferior&#46; Combinaci&#243;n&#58; colgajo de Karapandzic y colgajo de deslizamiento contralateral"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor and planned incision mark&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatologic surgery of the lip is challenging&#44; especially when defects are large&#44; difficult to close&#44; or might leave scars that can interfere with function or aesthetics&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> When direct closure is impossible&#44; the surgeon must choose the most appropriate technique for the location in order to avoid complications&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Therefore&#44; in the case we report we chose to close the wound with a Karapandzic flap combined with a contralateral sliding flap in order to ensure the functional integrity of the lip in accordance with the maxims of oncologic surgery on the face&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 54-year-old man with no personal or family medical history of interest&#44; a smoker since the age of 20&#44; presented with a tumor on the right lower lip of 6 months&#8217; duration&#46; He reported no bleeding&#44; although he had felt increased pain in the last few weeks&#46; Physical examination revealed a tumor 2<span class="elsevierStyleHsp" style=""></span>cm in diameter at the largest point&#46; The tumor was papilliform&#44; hyperkeratotic&#44; and had spread to the buccal mucosa at the labial commissure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The incision to remove the tumor included the full thickness of the skin and adequate margins &#40;1<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; The wound was then closed with a Karapandzic flap combined with a contralateral sliding flap&#46; The plane of dissection extended to the muscle&#44; and efforts were made to preserve the shape and function of the mouth&#46; The procedure was performed under general anesthesia and a local anesthetic &#40;2&#37; mepivacaine&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the early postoperative outcome&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The principal aim of oncologic surgery is to remove the lesion with tumor-free margins&#46; The choice of reconstructive technique depends on the anatomical region involved&#44; the depth and size of the tumor&#44; the characteristics of adjacent tissue&#44; and the surgeon&#39;s skill&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> If direct closure cannot be used because the defect is large and excessive tension would compromise function and aesthetics&#44; the surgeon&#39;s second choice would be to use flaps&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is no ideal method for lip reconstruction that avoids alterations of form or function such as microstomia or an incompetent oral commissure&#44; which is associated with chronic drooling if there is suspension&#46; If the lesion occupies more than a third of the lip&#44; flaps are usually used to reconstruct these defects&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The combination of a Karapandzic flap and a contralateral sliding flap provided several important advantages in this case&#58; the technique could be completed in a single procedure&#59; once the surgeon learns the technique it is accomplished quickly&#59; and an important network of vessels and nerves are preserved&#44; ensuring long-term safety with good movement and sensitivity&#46; Moreover&#44; this combination reduces the upper extension of the Karapandzic flap&#44; thus avoiding damage to vessels and nerves &#40;eg&#44; the terminal mandibular and buccal branches of the facial nerve&#41; that are sometimes associated with this flap&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The technique consists of excising the tumor and then cutting myocutaneous flaps&#44; dissecting the orbicularis oris muscle to locate the arterial and venous branches of the facial vessels while attempting to avoid the nerve branches&#46; The skin and muscle tissue can then slide forward&#44; leaving the underlying muscle intact&#46; These flaps are highly mobile and can be rotated toward the defect without constricting the vessels&#46; Care should be taken to control bleeding before suturing the wound&#46; The mucosal tissue and the muscle plane are first closed with absorbable sutures&#46; Nonabsorbable sutures are then used to close the skin&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Other techniques&#44; such as the V-block or the Estlander flap can cause functional complications and large defects&#46; They are also more likely to lead to microstomia&#46; The Gillies flap technique&#44; which is even more invasive and leads to more complications&#44; can be avoided when the surgical wound is to one side of the lip&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez-L&#243;pez I&#44; Mart&#237;nez-L&#243;pez A&#44; Ruiz-Carrascosa JC&#44; Ruiz-Villaverde R&#46; Cierre de grandes defectos en el labio inferior&#46; Combinaci&#243;n&#58; colgajo de Karapandzic y colgajo de deslizamiento contralateral&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;186&#8211;-187&#46;</p>"
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Información del artículo
ISSN: 15782190
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2019 Agosto 4 0 4
2019 Julio 4 0 4
2019 Junio 4 0 4
2019 Mayo 6 0 6
2019 Abril 2 0 2
2019 Marzo 2 0 2
2019 Febrero 2 0 2
2018 Diciembre 2 0 2
2018 Noviembre 1 0 1
2018 Septiembre 2 0 2
2018 Marzo 0 1 1
2018 Febrero 5 10 15
2018 Enero 4 9 13
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?