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Presentation

Repair Options for Lip and Nasal Defects Using Advancement, Island Pedicle, Rotation, and Forehead Flaps

Description

The speaker reviewed repair options for several facial defects, emphasizing practical decision-making based on wound size, location, tissue loss, and patient expectations. For a moderate upper lip defect after squamous cell excision, options included primary closure, dual island pedicle flaps, or mucosal advancement/island flaps; the speaker favored mucosal island flap techniques because they are highly mobile, heal well, and can be combined with secondary intention if needed, while careful undermining helps avoid dysesthesia and bleeding. For a modest nasal defect in an older patient with low cosmetic demands, the choices included primary closure, linear repair, bilobed or nasalisling-type flaps, or a cheek-based/keyhole approach; the speaker noted that cartilage can be shaved or stabilized with an intradomal stitch if closure is tight. For a larger combined upper lip and nasal/alar defect, the speaker preferred staging: first using a cheek-to-nose island flap to restore part of the defect, then later completing reconstruction with a forehead flap, which was described as reliable and straightforward when delayed. For another large facial wound, the speaker highlighted that secondary intention can sometimes produce excellent results, especially when the patient can tolerate it and when minimal intervention is aesthetically acceptable. Overall, the lecture stressed tailoring reconstruction to the defect, preserving function and cosmetic subunits, and using less invasive local flaps when possible, with forehead flaps reserved for more extensive full-thickness loss.

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Conclusions

For moderate upper-lip defects, direct closure is often acceptable, but mucosal island pedicle flap repair may better preserve function and reduce long-term scarring compared with full second-intention healing.
A limited mucosal IPF can be a practical first-line approach for lip defects because it mobilizes easily, heals well, and can be revised later if needed.
Careful undermining that preserves vessels and nerves is critical in mucosal flap surgery to avoid dysesthesia and bleeding.
For small nasal defects in older patients with low cosmetic expectations, simple primary closure or limited local flap repair is often sufficient and less burdensome than more complex reconstruction.
When closing nasal defects primarily, reducing cartilage or using supportive sutures can relieve tension and improve contour.
Keyhole/modified graft techniques can simplify nasal repair by allowing closure-driven tissue movement followed by grafting of the residual defect.
Large combined defects of the upper lip, nose, and ala are best managed in stages rather than with multiple major flaps on the same day.
In extensive nasal reconstruction, cheek-to-nose or island pedicle flaps can provide strong, well-camouflaged coverage while avoiding some of the morbidity of forehead flaps.
Delaying major nasal reconstruction until the wound declares itself can improve flap placement and help manage tissue contraction.
A forehead flap remains a reliable option for large full-thickness nasal defects, but staged reconstruction and patient-specific planning can make cheek-based flaps a less encumbering alternative in selected patients.
Guided second intention can sometimes produce excellent cosmetic outcomes, especially when combined with partial closure and careful wound selection.
Overall, the presentation emphasizes choosing the simplest reconstruction that meets functional goals, using staged and less invasive options when they can achieve comparable results.