Complications Following Local-Flap Lip Reconstruction After Tumor Removal: A Systematic Review

Abstract

Local flap reconstruction plays a critical role in managing defects following lip tumor removal. The aim of this review is to evaluate complications associated with local flap reconstruction for lip tumor removal. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed (MEDLINE) database was queried from 2014 to 2024 with the following keywords: ("lip reconstruction" OR "cheiloplasty" OR "local flap") AND ("outcomes" OR "functional" OR "postoperative" OR "complications" OR "clinical"). Only retrospective and prospective studies, case series, randomized controlled trials, original research, and studies with patients requiring local flap reconstruction for tumor removal were included. We excluded studies that were related to cleft lip reconstruction, lip infection, burns, arteriovenous malformations (AVM), animal studies, technical reports, cadaveric studies, case reports, and review articles. After removal of duplicates and screening of titles, abstracts, and full-length text, 18 of the 749 initial articles were included in this review. The mean age across the articles was 66 ± 8 years (253 males; 124 females) with an average follow-up time of 23 ± 10 months. All of the studies included patients with squamous cell carcinoma (SCC), and only six of them analyzed patients with basal cell carcinoma (BCC). All studies included patients with bottom lip pathology, and only three with top lip pathology. The mean complication rate was 8% across the studies. The most common reported complication was wound dehiscence (9/18), followed by paresthesias (7/18), microstomia (5/18), sialorrhea (4/18), and flap necrosis (2/18). The most common local flaps included: seven instances of Karapandzic, four instances of Abbe flaps, one case of Yu flap, two instances of step technique flaps, one case of Gillies flap, and two mentions of Webster flaps. Complications were reported in nine of the 19 articles. Local flap techniques provide favorable aesthetic and functional outcomes in lip reconstruction. However, current outcome measures vary widely, often including aesthetic evaluations, functional assessments, and complication rates, without standardized reporting. To enhance comparability and improve practice, surgeons should adopt standardized frameworks for reporting outcomes, such as validated tools for aesthetic and functional assessment (e.g., FACE-Q, PROMIS). Incorporating pre- and postoperative patient-reported outcomes, uniform complication classifications, and multi-center data collaboration will enable more consistent evidence-based decision-making and optimize patient care. Future studies should seek to utilize these practices for uniform reporting and improving patient outcomes.

Keywords: aesthetic outcomes; flap complications; head and neck surgery; lip reconstruction; local flap reconstruction; oral cancer reconstruction; plastic surgery; reconstructive surgery; surgical outcomes; wound healing.

Figure 1. PRISMA Flow Diagram

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses