Defect transport for management of lower lip ectropion
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IDEAS AND INNOVATIONS Defect transport for management of lower lip ectropion Vishwa Prakash & Raman Tandon & Neha Chauhan Received: 17 February 2013 / Accepted: 27 April 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Burn is a devastating condition and post-burn se- quelae are common after deep burns. Post-burn ectropion of the lower lip is one of them. The usual treatment is release of ectropion of the lower lip and resurfacing of the defect with a split thickness skin graft. Several other procedures have been described in literature. We have used a new concept to trans- port the defect, resulting after releasing the lower lip ectropion, to the suprahyoid region. The mental defect is covered by a bipedicled flap transposed from the suprahyoid region and the donor defect is grafted with a split thickness skin graft. We have used this technique in three adult females with post-burn lower lip ectropion obtaining good aesthetic appearance and no recurrences. Level of Evidence: Level V, therapeutic study. Keywords Burn injuries . Face . Lower lip . Ectropion . Bipedicled flap Introduction Post-burn ectropion of the lower lip is common after deep burn injuries of the face. The usual method of the treatment is release of ectropion and resurfacing of the defect with skin graft. The main disadvantages of the procedure are poor aesthetic appearance of the grafted skin over the defect and high incidence of recurrence. Flaps like mental V-Y ad- vancement flap [1] and nasolabial–orbicularis oris flap [2] were also been described for reconstruction of smaller areas of the lower lip but not for post-burn ectropion of lip. Other described methods are partial vermilionectomy, tightening of the orbicularis oris and wedge excision of the excess lower lip length following the ectropion release [3]. We designed a new method of defect transport for management of the lower lip ectropion in which the defect, resulting after the release of contracture, is shifted to the suprahyoid region by using a bipedicled flap from the suprahyoid region. Surgical technique The surgery is usually carried out under general anaesthesia and strict antiseptic measures. An incision is made just below the vermilion of the lower lip and the scar tissue is removed achieving a complete release of the ectropion (Figs. 1 and 2). A bipedicled random pattern skin flap is then harvested from the suprahyoid region and transposed to resurface the mental defect (Fig. 3). In this way, the defect is shifted to the suprahyoid region where is covered using an split thickness skin graft fixed with staples or a tie-over dressing. After flap healing, we advised massage with coconut oil and pressure garment wear for 3 months. Results Three patients were treated using this technique. All of them were female by chance and had multiple post-burn sequelae. These patients came to us after receiving initial treatment somewhere else and once a complete healing of their burn wounds was achieved. All the three patients did well with complete flap survival. The colour of the bipedicled flap matched very well with the surrounding tissues. The grafted area was well hidden under the chin achieving a good aesthetic appearance (Figs. 4 and 5). Although no exact measurements from the ectropion lip margin were taken, during a six month follow-up no recurrence was detected. Discussion Lower lip ectropion is one of the most common sequelae of deep facial burns. The commonest method of correction is ectropion release and resurfacing of the defect with skin grafts. Notwith- standing, the skin graft over the chin and lip area gives V. Prakash : R. Tandon (*) : N. Chauhan Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital, New Delhi, India e-mail: [email protected] Eur J Plast Surg DOI 10.1007/s00238-013-0853-0
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Transcript of Defect transport for management of lower lip ectropion
IDEAS AND INNOVATIONS
Defect transport for management of lower lip ectropion
Vishwa Prakash & Raman Tandon & Neha Chauhan
Received: 17 February 2013 /Accepted: 27 April 2013# Springer-Verlag Berlin Heidelberg 2013
Abstract Burn is a devastating condition and post-burn se-quelae are common after deep burns. Post-burn ectropion ofthe lower lip is one of them. The usual treatment is release ofectropion of the lower lip and resurfacing of the defect with asplit thickness skin graft. Several other procedures have beendescribed in literature. We have used a new concept to trans-port the defect, resulting after releasing the lower lipectropion, to the suprahyoid region. The mental defect iscovered by a bipedicled flap transposed from the suprahyoidregion and the donor defect is grafted with a split thicknessskin graft. We have used this technique in three adult femaleswith post-burn lower lip ectropion obtaining good aestheticappearance and no recurrences.Level of Evidence: Level V, therapeutic study.
Keywords Burn injuries . Face . Lower lip . Ectropion .
Bipedicled flap
Introduction
Post-burn ectropion of the lower lip is common after deepburn injuries of the face. The usual method of the treatmentis release of ectropion and resurfacing of the defect withskin graft. The main disadvantages of the procedure are pooraesthetic appearance of the grafted skin over the defect andhigh incidence of recurrence. Flaps like mental V-Y ad-vancement flap [1] and nasolabial–orbicularis oris flap [2]were also been described for reconstruction of smaller areasof the lower lip but not for post-burn ectropion of lip. Otherdescribed methods are partial vermilionectomy, tighteningof the orbicularis oris and wedge excision of the excesslower lip length following the ectropion release [3]. Wedesigned a new method of defect transport for managementof the lower lip ectropion in which the defect, resulting after
the release of contracture, is shifted to the suprahyoid regionby using a bipedicled flap from the suprahyoid region.
Surgical technique
The surgery is usually carried out under general anaesthesiaand strict antiseptic measures. An incision is made justbelow the vermilion of the lower lip and the scar tissue isremoved achieving a complete release of the ectropion(Figs. 1 and 2). A bipedicled random pattern skin flap isthen harvested from the suprahyoid region and transposed toresurface the mental defect (Fig. 3). In this way, the defect isshifted to the suprahyoid region where is covered using ansplit thickness skin graft fixed with staples or a tie-overdressing. After flap healing, we advised massage withcoconut oil and pressure garment wear for 3 months.
Results
Three patients were treated using this technique. All of themwere female by chance and had multiple post-burn sequelae.These patients came to us after receiving initial treatmentsomewhere else and once a complete healing of their burnwounds was achieved. All the three patients did well withcomplete flap survival. The colour of the bipedicled flapmatched very well with the surrounding tissues. The graftedarea was well hidden under the chin achieving a good aestheticappearance (Figs. 4 and 5). Although no exact measurementsfrom the ectropion lip margin were taken, during a six monthfollow-up no recurrence was detected.
Discussion
Lower lip ectropion is one of the most common sequelae of deepfacial burns. The commonest method of correction is ectropionrelease and resurfacing of the defect with skin grafts. Notwith-standing, the skin graft over the chin and lip area gives
V. Prakash : R. Tandon (*) :N. ChauhanDepartment of Burns, Plastic and Maxillofacial Surgery,Safdarjung Hospital, New Delhi, Indiae-mail: [email protected]
Eur J Plast SurgDOI 10.1007/s00238-013-0853-0
unaesthetic appearance and also higher recurrence rates.We haveused the method of “central segment expansion” [4, 5] in themanagement of post-burn contractures and applied the sameprinciple in the management of post-burn lower lip ectropionalso, but the aesthetic results were not good. So, we havedeveloped a new concept of “defect transport” in the manage-ment of ectropion of the lower lip, in which the defect createdafter the release of the ectropion is shifted to the suprahyoidregion adjacent to the defect by transposing a bipedicled flapfrom the suprahyid region to the mental region. The defecttransported inferiorly to the suprahyoid region is skin grafted.We have not used a full thickness skin graft but it could be abetter alternative to improve the cosmetic results. Defecttransport has been used in different clinical situations suchas when a scalp defect with bone exposure is covered with alocal flap and the secondary defect is grafted. However, it isnot exactly akin to the defect transport described here. Defecttransport is a new concept for the management of post-burnectropion of the lower lip. It gives a better cosmetic result andhas a lower incidence of recurrence. All patients included inthis series were satisfied with the final results.
Conflict of interest None
Patient consent: Patients provided written consent for the use oftheir images.
References
1. Bayramichi M, Numanoglu A, Tenzel E (1997) The mental V-Yisland advancement flap in functional lower lip reconstruction. PlastReconstr Surg 100:1682–1690
2. Prema D, Kingsly PM, Shashank L, Rahul S, Petkar KS, Sreekar H(2011) Single-stage functional reconstruction of the post-burn lowerlip. Eur J Plast Surg 34:33–39
3. Jemee B, Sanders R (1999) A functional variant of lower lip recon-struction. Br J Plast Surg 52:232–235
4. Prakash V, Srivasatva RK, Mishra A (2004) Central segment ex-pansion method for management of postburn contracture of ankle.Plast Reconstr Surg 113:1301
5. Prakash V (2001) Central segment expansion for release of webspace contractures. Plast Reconstr Surg 108:1446–1447
Fig. 2 Release of contracture of the lower lip and resulting defect
Fig. 1 Preoperative view of lower lip ectropion
Fig. 3 The bipedicled flap is transposed while the defect transported tothe suprahyoid region is grafted
Fig. 4 Postoperative view showing the correction of the lower lipectopion and the aesthetic improvement of the mental region
Fig. 5 Postoperative view showing the donor site covered with a skingraft. With time the grafted area tends to contract becoming smaller
Eur J Plast Surg
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