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roll due to the possibility of retraction and lip deformity after healing. Full-thickness defects can often be
closed primarily if they involve less than one-third of the width of the lower lip. Larger defects often
necessitate the use of local flaps. Rearrangement of lip tissue utilizing advancement flap techniques such as
the Karapandzic flap or pedicled flap techniques such as the Abbe and Estlander flaps allow for the
replacement of like tissue with like tissue. However, in cases where existing lip structure is lacking to the
point that more distant tissue must be recruited, options such as the perialar crescentic advancement flap
are useful. Mucosal advancement flaps are often used in conjunction with local skin flaps to reconstruct the
mucosal components of multilaminar, full-thickness defects. The rotational flap most utile for
reconstruction is the inferiorly based melolabial flap which has been described in a previous section.

CONCLUSION
Facial reconstruction requires careful consideration of the unique qualities of each facial subunit and the
corresponding advantages and risks of each type of reconstructive option. Often, local skin flaps provide the
best result with the least morbidity. As described, rotation and transposition flaps can be utilized
successfully for facial reconstruction when the flap is chosen correctly and is well designed and executed.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data review and
drafted the manuscript text and created the figures: Sciegienka S
Made substantial contributions to conception and design of the study and performed data review and edits
of manuscript: Hanick A
Made substantial contributions to conception and design of the study and provided insights and final edits
to the manuscript: Branham G

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Dr. Gregory Branham (corresponding author) has given permission to use the figures.

Copyright
© The Author(s) 2022.

REFERENCES
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reconstruction: Thomas procedures in facial plastic surgery. Shelton, CT: People’s Medical Pub. House; 2011. p. 31-51.
2. Baker SR. Rotation flaps. Local flaps in facial reconstruction. 3rd ed. Philadelphia, PA: Elsevier/Saunders; 2014. p. 100-23.
3. Earnest LM, Byrne PJ. Scalp reconstruction. Facial Plast Surg Clin North Am 2005;13:345-53, vii. DOI PubMed
4. Branham GH. Forehead and Brow Reconstruction. In: Branham G, Thomas JR, editors. Facial soft tissue reconstruction: Thomas
procedures in facial plastic surgery. Shelton, CT: People’s Medical Pub. House; 2011. p. 89-96.