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Tailoring Folded-Fasciocutaneous Flap for the Restoration of Oral Commissure Morphology

Chen, Yo-Shen MD*; Lin, Pin-Yi DDS; Hu, Kwang-Yu DDS; Lin, Tsuo-Wu MD*

doi: 10.1097/SAP.0000000000000038
Clinical Papers

Abstract: The reconstruction of a through-and-through cheek defect with oral commissure involvement can be challenging. When attempting to reconstruct its seam-like structure or to replace its supple lip tissue, postoperative morbidities such as drooling, microstomia, and poor aesthetic appearance can often occur and be difficult to correct. After inspecting the oral commissure, one can observe that the morphology of the upper lip acts as a “drape” hanging over the upper teeth, whereas the lower lip functions similarly to a “dam” holding the constant pour of saliva within the oral cavity. We noted that if we tailored a single fasciocutaneous flap to satisfy these morphologies during reconstruction, not only were the mentioned morbidities of reconstruction greatly diminished, but the reconstructed oral commissure could also spontaneously mimic the contralateral side in form. We presented 10 consecutive patients with cheek defects with concomitant oral commissure involvement, which underwent reconstruction by using a single-folded fasciocutaneous flap. We described how the flaps are tailored to suit the mentioned upper and lower lip morphology. For certain defects, such as a cheek defect with oral commissure involvement, the loss of functional morphology greatly outweighs its anatomical or tissue losses. Our method provides a simple and straightforward surgical option in this area, which was previously perceived as a challenging reconstruction site.

From the Departments of *Plastic Surgery, and †Oral Maxillofacial Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan, Republic of China.

Received October 1, 2013, and accepted for publication, after revision, October 6, 2013.

Preliminary result presented at the annual meeting of the Plastic Surgical Association of Taiwan, Taipei, Taiwan, 2007 (Title: Drape-and-Dam Flap Design for the Reconstruction of Through-and-Through Cheek Defect with Involvement of Oral Commissure).

Conflicts of interest and sources of funding: none declared.

Reprints: Yo-Shen Chen, MD, Department of Plastic Surgery, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section 2, Banqiao, Taipei, Taiwan, Republic of China. E-mail: chenyoshen@yahoo.com.

© 2013 by Lippincott Williams & Wilkins