Clinical Bottom Line:
- One should start with a small wound using this technique.
- Freeing up a bilateral advancement flap.
- This is a superior technique for closing defects of the upper lip.
More than 50 percent of all skin cancers are found on the peri-nasal area, including the nose. The next most common site is the upper lip. After removal of skin cancers from the upper lip, they vary in size from very small to very extensive lesions involving the nasal vestibule and the nasolabial folds, as well as the upper lip. I am directing this pearl to regions of approximately 2 cm or less of the upper lip. The standard modalities for correction of the surgical defect would be advancement flaps, rotation flaps or transposition flaps. Without elaborating on the different methods, my technique of choice would be a wedge resection, which one could also call a bilateral advancement flap.
There are two types of advancement flaps, as seen in the first case which entails freeing up two horizontal skin flaps and bringing them together.
Potential pitfalls: There could be a pitfall, if one cuts the hair follicles, and the end result is a field of alopecia. Another problem is the distortion of the lip, if the two skin flaps are not long enough when brought together.
Technique: I have selected the wedge section to close the wound. First, with a marking pen, outline the area using three times the length to one time its width. This may entail cutting into the upper lip itself. The area is first anesthetized using lidocaine with epinephrine. If it entails cutting into the lip, I like to score with a scalpel, very gently the vermillion borders, as when brought together, they can be approximated precisely to each other. The excess tissue is removed and bleeding is controlled using electro-cautery, a number of absorbable buried sutures are used to close the wound. A running 5-0 suture is then used to close the skin. The skin sutures are usually left in place for one week, then removed. The end result will be a good cosmetic result and no distortion of the lip.