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Kannan et al. Plast Aesthet Res 2018;5:4 Plastic and
DOI: 10.20517/2347-9264.2018.02 Aesthetic Research

Original Article Open Access

The labio-mandibular flap for upper lip and peri-
commissural defects

Ruben Yap Kannan, Charles Nduka
Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ, UK.

Correspondence to: Dr. Ruben Yap Kannan, Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ,
UK. E-mail: ruben.kannan@gmail.com
How to cite this article: Kannan RY, Nduka C. The labio-mandibular flap for upper lip and peri-commissural defects. Plast Aesthet Res
2018;5:4. http://dx.doi.org/10.20517/2347-9264.2018.02

Received: 8 Jan 2018 First Decision: 24 Jan 2018 Revised: 26 Jan 2018 Accepted: 27 Jan 2018 Published: 31 Jan 2018
Science Editor: Raúl González-García Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Aim: Peri-commisural defect reconstruction using the Abbe or Estlander flaps tend to pilfer tissue from the lower lip,
contributing to microstomia, with its attendant problems. In this study, we aim to design a flap for more superficial defects,
in which the underlying orbicularis oris muscle can be preserved when resecting peri-commisural skin malignancies whilst
also ensuring completeness of excision.

Methods: In a retrospective case review of 7 cases at our institution over a 12-month period (2016-2017), we conceptually
designed a perforator-plus fascio-cutaneous flap from within the labio-mandibular fold with a 6-month follow-up in terms
of oncological clearance and aesthetic outcome. The cohort was composed of patients with skin cancers e.g. basal and
squamous cell carcinomas, presenting to a tertiary care facial plastic surgery centre. The technique involved raising a flap
from within the peri-oral area, with a scar disguised along the labio-mandibular and naso-labial folds which allows for both
an aesthetic reconstruction and the preservation of the oral sphincter mechanism, by avoiding microstomia. The outcomes
measured were (1) to ascertain whether this procedure is oncologically safe, (2) there were instances of microstomia and (3)
aesthetic appearance.

Results: All oncological lesions were completely excised in all cases and at up to six months’ follow-up, there were no
instances of recurrence. Functionally, oral sphincter function was preserved in all instances as was aesthetic appearance.

Conclusion: The labio-mandibular flap is an oncologically safe procedure for skin cancers whilst preserving oral sphincter
function and maintaining aesthetics. It is hence, a superior alternative to Abbe and Estlander flaps, for more superficial
defects, not requiring mucosal excision.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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