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Extended Karapandzic Flaps for Near-Total and Total Lower Lip Defects

Hanasono, Matthew M. M.D.; Langstein, Howard N. M.D.

Plastic & Reconstructive Surgery: March 2011 - Volume 127 - Issue 3 - pp 1199-1205
doi: 10.1097/PRS.0b013e318205f3ce
Reconstructive: Head and Neck: Original Articles

Background: Karapandzic flaps consist of well-vascularized, sensate lip tissue but are generally restricted to reconstruction of defects comprising two-thirds of the lip or less to avoid microstomia. Reconstruction of larger defects usually involves advancement flaps that require significant cheek laxity or free tissue transfer.

Methods: The authors describe a modification of the Karapandzic lower lip reconstruction technique in which the flaps are extended by recruiting tissue from the perioral cheek, allowing reconstruction of near-total and total lower lip defects, which would normally not be reconstructible using the standard technique. Neurovascular structures are carefully dissected and preserved to ensure innervation and perfusion.

Results: Eight patients underwent successful single-stage lower lip reconstruction with this technique. In three cases, bilateral extended Karapandzic flaps were used for total lower lip defects, and in five additional cases, unilateral extended Karapandzic flaps were combined with other local flaps for near-total defects. All patients achieved oral competence and normal or near-normal mouth opening. One patient developed a hematoma and one patient developed a fistula that healed with conservative treatment. There were no other complications.

Conclusions: Extended Karapandzic flaps can be used to reconstruct near-total or total lower lip defects with innervated, well-vascularized tissues that recreate the oral sphincter and restore oral competence. By extending conventional Karapandzic flaps with perioral cheek tissue, adequate length is gained to avoid microstomia. In addition, the color match of the reconstructed lip is superior to reconstructions relying on tissue transfer from distant sites.


Houston, Texas; and Rochester, N.Y.

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, and the Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center.

Received for publication July 21, 2010; accepted September 17, 2010.

Disclosure: Neither of the authors has any commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Matthew M. Hanasono, M.D.; Department of Plastic Surgery; University of Texas M. D. Anderson Cancer Center; 1515 Holcombe Boulevard, Unit 443; Houston, Texas 77030;

©2011American Society of Plastic Surgeons