Pre-expanded bipedicled visor flap: an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males

Abstract

Background: Reconstruction of upper and lower lip subunits is a complicated and elusive challenge. For patients affected by defects involving upper and lower lip subunits, a technique able to reconstruct both aesthetic units with matched colour, sufficient contours and similar texture would be ideal. In this study, we present our experience with upper and lower lip reconstruction using the pre-expanded bipedicled visor flap.

Methods: From January 2014 to January 2017, 12 male patients presenting with defects of the upper and lower lip subunits were treated using this surgical technique. After a period of expansion of the scalp flap of over 6 months, the bipedicled visor flap was raised from both the parietal regions and rotated to resurface the defect. Delay and section of the pedicle were then performed.

Results: Twelve male patients with postburn scars aged 22 to 48 years (mean: 34 years) were successfully treated with no major complications. The donor site was closed primarily in all cases. Subsequent flap debulking and minor revisions were performed under local anaesthesia between 6 and 12 months postoperatively.

Conclusions: The pre-expanded bipedicled visor flap provides an effective and reliable option for upper and lower lip reconstruction with excellent colour and texture. It is feasible to achieve these results simultaneously from a single donor site by using a pre-expanded bipedicled visor flap.

Keywords: Lip defect; Postburn; Pre-expanded; Reconstruction; Visor flap.

Figure 1.

Preoperative estimate was performed. The sagittal width of the expanded parietal scalp (curve a), the width of pocket for expander (curve b) and the maximal vertical width of facial burn scar (curve c) were precisely measured

Figure 2.

The resurfacing territory was marked by methylene blue according to upper and lower lip units

Figure 3.

Case 1. A 47-year old man had severe burn scars in his upper and lower lips. (a) Preoperative view. (b) Patient underwent tissue expansion in scalp area. (c) scars were excised in upper and lower lip. Bipedicled visor flap was marked with facial landmarks according to the defect. Superficial temporary vessels were then exposed on either side. (d) Flap was harvested and sutured to recipient site and donor site was able to be closed primarily. Visor flap underwent delay and pedicle divisions. (e) The results at 12-month follow-up

Figure 4.

Case 2. A 32-year old man had severe burn scars involving his entire lower face and neck. (a) Preoperative view. The patient successfully underwent tissue expansion in cervical area. (b) Superficial temporary vessels were exposed on either side. Flap was harvested and sutured to recipient site. Donor site was closed primarily. (c) 6 Vaseline gauzes as compressive garment were used to enhance tissue adhesion. The visor flap was well vascularized with obvious hair growth after 6-weeks delay. The results at 6 and 24 months postsurgery were excellent