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Introduction
CHAPTER 40 Reconstruction of the
Lips
J. Michael Wentzell Glenn D. Goldman
SUMMARY
Lip reconstruction has significant aesthetic and functional implications.
Attention to cosmetic subunits, as well as important landmarks such as the white
line, is of paramount importance.
Linear and wedge repairs are generally most straightforward, though larger
defects benefit from a variety of flap approaches.
Beginner Tips
Small defects on the upper and lower cutaneous lip may be repaired in a linear
fashion; aim to orient closures along existing creases if possible.
Advancement flaps are frequently performed for mid-size defects on the upper
cutaneous lip; incise parallel to and 1 mm from the vermilion border for ideal camouflage.
Expert Tips
While island pedicle flaps have a reputation for undesirable scarring, this can be
largely obviated by judicious undermining and meticulous suturing.
If the nasolabial fold is blunted, Z-plasty can be considered approximately 6 months
postoperatively.
Partial closures may be useful in select patients, particularly those reluctant to undergo
larger procedures.
Donโt Forget!
Z-plasty may be useful for the management of trigone deformities.
Mucosal advancement flaps should be performed with a minimal number of buried
sutures.
Pitfalls and Cautions
The white line in younger patients is very pronounced; deviation of less than 1 mm
may still yield a cosmetically obvious mismatch.
Larger lip reconstructions, such as the Karapandzic flap, must be performed precisely
to avoid disastrous outcomes.
Patient Education Points
Always gauge a patientโs willingness to undergo and recover from an extensive
procedure before it is initiated.
Some patients may prefer a small partial closure to a more involved and much larger
flap.
Patients should be warned against opening their mouths wide, eating fruit such as
apples, and other activities that stretch the orbicularis oris in the immediate postoperative period.
Billing Pearls
Most flaps on the lips are coded with 14060 or 14061, and these codes include the
excisional component; it is not appropriate to bill both an excision and a flap repair code simultaneously, except for Mohs excision codes.
When coding a flap, graft, or linear repair, medical necessity is the ultimate arbiter of
appropriateness.
CHAPTER 40 Reconstruction of the