Solving the Dilemma of Reconstructing Full Thickness Lower Lip Defects: Our Experience with the Sandwiched Nasolabial Flaps

The reconstruction of lip defects while maintaining its functional and esthetic properties serves a daunting challenge to the surgeon. Various surgeons have described variety of techniques, ranging from local composite flaps to free flaps. But not one single procedure has fulfilled all requirements. We describe a novel method of using bilaterally harvested subcutaneous naso-labial (NL) flaps sandwiched onto each other with a bucket handle mucosal transfer from upper lip to reconstruct full thickness lower lip and vermilion defects in 10 patients.

A retrospective review of the data of 10 patients of carcinoma of the lower lip reconstructed with this technique between April 2019 and May 2022 was done. Patient- and disease-related factors along with flap-related complications were analyzed.

The bilateral NL flaps were used for construction of lower lip defects in 10 male patients. Mean age of the study population was 49.7 years (41–60 years). Major or minor complications were seen in 5 patients (50%). Complete flap loss was seen in one patient; three patients suffered from partial necrosis of the distal end of the outer flap. Two patients developed oral incontinence and two patients were referred to a speech therapist for partially unintelligible speech.

Ease of harvest, short learning curve, similar skin color as of the lost skin, a versatile blood supply with minimal morbidity and satisfactory outcomes makes the bilateral subcutaneous NL flaps sandwiched onto each other a potentially acceptable method of reconstructing full thickness lower lip defects.