Hybrid Reconstruction of a Large Traumatic Lower Lip Avulsion Defect Utilizing Cleft Lip Reconstruction Techniques to Optimize Outcomes

Large defects of the lip pose a reconstructive challenge due to the prominent facial location, significant impact on self-image and quality of life, and effects on functional needs such as oral competence, sensation, articulation, and maintenance of normal range of incisal opening. Current lip reconstruction practice follows guidelines based on defect depth and size. Optimal outcomes are achieved with use of local tissues which achieve better color, texture match, and ability to maintain sensation and orbicularis function. However, this is not usually possible in large defects. Cleft repair principles revolve around many of the similar goals of traumatic and oncologic lip reconstruction-to improve function and aesthetics. The authors present a case of a young male who sustained a traumatic lower lip avulsion defect involving greater than 75% of his lower lip. This was fully reconstructed using principles borrowed from cleft lip component repair, thus eliminating the need for a free flap without or without a tendon graft. This approach optimized aesthetic and functional outcomes, while avoiding several of the drawbacks of the classic oral flap reconstruction, especially in a young patient without static rhytids to camouflage reconstructive scars. In the presented technique, the senior author (OAA) successfully designed a modification of the classic Karapandzic repair technique utilizing principles from cleft lip reconstruction to address skin, muscle, and mucosa in separate components. This new modification of a classic technique presented by the authors utilizes principles from cleft lip reconstruction for improved functional and aesthetic outcomes in a single-stage reconstruction. This cross-pollination of principles resulted in the successful modification of traditional techniques leading to improved aesthetics, sensate reconstruction, complete oral competence, good maximal incisal opening and color match, and decreased scar burden.