Mustarde cheek rotation flap for lower eyelid repair. Karapandzic flap, lips, squamous cell carcinoma how to cite this article. Patient was taken under general anaesthesia for secondary repair of lip with karapandzic flap. The karapandzic technique is easy in perform and provides excellent results for full thickness defects larger than one. The flap comes from both directions to meet in the middle of the defect. Karapandzic flap is a modification of gilles fan flap is used for the reconstruction of total and subtotal defectof lower lip. A study by gonzalez and etchichury indicated that combining standard karapandzic and abbe flaps is an effective means of repairing large lower lip defects following mohs surgery. The biggest advantage of the karapandzic flap is the preservation of the mobility and the sensibility of. The incision is then continued laterally to the preauricular crease toward the level of the earlobe. Reconstruction after wide excision of primary cutaneous.
For example, cheek advanced flap, gillies fan flap, mcgregor fan flap, karapandzic technique, nasolabial flap, free flap and so on. Reconstruction with karapandzic flaps has the advantage of being a singlestage technique that replaces the missing lower lip with like tissue. The karapandzic reconstruction of lip defects is a versatile, anatomically sound, physiologically and cosmetically acceptable method that should be known to all surgeons who excise lip cancers. The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. If the commissure is involved, both the karapandzic and estlander flaps may be. It provides good oral competence and is useful for closing onehalf to twothird defects of the upper lip and defects up to threequarters of the lower lip. Karapandzic flap is a reliable technique with consistent functional and esthetic outcome. Lip reconstruction, modified extended karapandzic flap, depressor anguli oris. Lower lip reconstruction using the karapandzic technique. It is designed around the melolabial and labiomandibular creases figure 1c, which divide the facial subunit borders between the upper and lower lips and the cheek.
Lower lip reconstruction using the karapandzic technique rbcp. The operative technique for identification of neurovascular bundle is. The fan flap is similar to the estlander flap in that it revolves rotation of tissue around the commissure. Free flaps should be reserved for oral cavity and mandibular reconstruction, if needed. Extended karapandzic flap technique for reconstruction of lower. Wedge shaped flap based onwedge shaped flap based on inferior labial artery, is rotatedinferior labial artery, is rotated around angle of mouth into thearound angle of mouth into the fect. In large defects, it might result in disproportion between the upper and lower lips and blunting of the commissures.
Methods all patients presenting to the senior author y. Karapandzic flap for esthetic and functional reconstruction of. Karapandzic flap and bernardburrowwebster flap for reconstruction of the lower lip. Adequate lip and cheek tissue is necessary for full mobilization of the flap and previous surgical. Rbcp the use of the karapandzic flap for reconstruction. Six patients underwent successful twostage lower and upper lip reconstruction with this technique. The difference is that it maintains the nerve and blood supply of the orbicularis oris. A complete lip is formed by rotating upper lip and perioral tissue down and. It can be used in defects of more than twothirds of the lip, extending to the cheek, commissural reconstruction, and secondary reconstruction. Reconstruction of total fullthickness lip defect is a challenging task. Your jaw may be rebuilt using bone from another part of your body the donor site. They are particularly notorious due to the polymicrobial nature of human saliva inoculated in the wound and the risk they pose for transmission of infectious diseases. Innervated musculocutaneous lip flap karapandzic technique. Extended karapandzic flap technique for reconstruction of.
It involved bilateral full thickness circumoral advancement rotation 11, 12 of the flap. The karapandzic flap is a reliable technique that offers consistently good functional and esthetic outcomes after reconstruction of lip defects. Sensory innervation of upper lip is derived from superior labial branches of the infraorbital nerve. Reconstruction of the lower lip using karapandzic and. In 1974, karapandzic 4 described a modification of the gillies fan flap, presenting a more conservative technique, carefully dissecting and preserving nerves and the labial artery.
The advantage of the technique is that restoration of the orbicularis oris muscle is possible in a single surgery, restoring lip functionality and. Karapandzic flap is one the most commonly used technique for reconstruction of large defects of the lower lip. An artery, vein, and soft tissue will also be removed with the bone. The karapandzic flap is an axial musculomucocutaneous flap based on the superior or inferior labial arteries figure 1a and b. Pdf karapandzic flap for esthetic and functional reconstruction. This is a sensate axial musculomucocutaneous flap based upon the superior and inferior labial arteries. Reconstruction of the lower lip using karapandzic and gilles flaps.
While the bernardburrowwebster flap usually requires general anaesthesia, the karapandzic flap can eventually be performed under loco regional anaesthesia. Reconstruction of subtotal defects of the lower lip. Karapandzic flap and bernardburrowwebster flap for. This flap borrows tissue from the sides of the defect, like the gilles flap. Undermining is done in a subgaleal plane and deep sutures should be placed through galeal layer to ensure adequate strength. In 2011, an extended karapandzic flap technique was described by sood et al. The mainstay of management of primary cutaneous melanoma is wide surgical excision, but occassionally a balance is needed between adequately resecting a potentially curable lesion and minimising the functional deficit or cosmetic deformity in the affected area, particularly in the head and neck region. It is a modification of the gillies fan flap 3, which is best indicated for the reconstruction of central defects. The karapandzic technique was introduced in 1974 for lower lip reconstruction. A wide subcutaneous undermining proceeds, the extent of which is determined by the laxity of the skin and the extent of the defect. Estlander flap 1872estlander flap 1872 similar to abbe flap atsimilar to abbe flap at missure.
Larger mediumsized defects can usually be reconstructed with some type of crosslip flap such as abbe and estlander, depending on whether the oral commissure is involved. Therefore, this flap is a useful option in cases that are limited by significant microstomia and by limited oral access when a karapandzic flap is used. The split orbicularis myomucosal flap for lower lip. Human bite injuries are both deceptive and challenging in their presentation and management. It is performed with semicircular incisions, extending from the inferior margins of the lesion to the nasal wings. The flap overcomes the drawbacks of karapandzic technique, which is microstomia, and of bernard technique, which is a tight adynamic lower lip. We recently repaired total or near total fullthickness lower lip defect by our modified extended karapandzic flaps and got satisfactory results. The karapandzic flap in lower lip reconstruction the karapandzic flap in lower lip reconstruction degala, saikrishna. Surgical technique the split orbicularis myomucosal flap. Lower lip reconstruction using the karapandzic technique scielo.
The abbe flap is useful as a lip balancing procedure and avoids the rounding of the commissures. Lip reconstruction for defects greater than 80 % present a challenge in maintaining acceptable oral function and good aesthetic results. Sophus august vilhelm stein of copenhagen, denmark, described bilateral upper cen. In 2011, an extended karapandzic flap technique was described by. The reconstructive surgeon must have wide knowledge of reconstructive techniques. Results a total of 14 patients with a minimum followup of 6 months mean, 3. Early treatment, appropriate prophylaxis and surgical evaluation are the key to achieving desired treatment outcomes. Based on a previously described procedure of the karapandzic technique1, marking for the right flap. The flap ls slid and rotated into position while an intact neurovascular pedicle is maintained. Karapandzic flap for reconstruction of lip defects. In 6 patients who received a 2stage doublereversed abbe flap, there was a 90% satisfaction rate, no functional complaints at 3month followup, and no problems with asymmetry or loss of sensation. Modified extended karapandzic flap for large lower lip. Lip reconstruction after tumor ablation world journal of plastic.
Among the reconstruction techniques described for the lower. Accordingly, sensation and circulalion of the lip is preserved and function of the orbicularis oris muscle is maintained. Karapandzic modified this technique in order to reconstruct central lower lip defects measuring 3. Karapandzic flap gaffar khan aa, kulkarni jv indian j dent. Karapandzic flap this is a sensate axial musculomucocutaneous flap based upon the superior and inferior labial arteries. The karapandzic flap in lower lip reconstruction, journal. Reconstruction of large defects of the lower lip after. Moreover, this combination reduces the upper extension of the karapandzic flap, thus avoiding damage to vessels and nerves eg, the terminal mandibular and buccal branches of the facial nerve that are sometimes associated with this flap. The key feature of this reconstruction technique is preserving the neural and vascular structures that are encountered in the plane of dissection, so that. Paramedian forehead flap iowa head and neck protocols. Summary the karapandzic technique is easy in perform and provides excellent results for full thickness defects larger than one. Karapandzic flap, a possible solution to a case of. Larger defects but less than a subtotal or total lip defect can often be reconstructed with variations of the classic karapandzic, gillies fan, or bernardburow flaps. Karapandzic flap for esthetic and functional reconstruction of large defect of lower lip.
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