*Konrad Wroński1, Zbigniew Masłowski2, Leszek Frąckowiak3, Janusz Kaczor2
Gillies fan flap for lower lip reconstruction – case report
1Department of Surgical Oncology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland
Head of Department: Monika Rucińska, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
3Department of Public Health and Epidemiology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland
Head of Department: prof. Anna Abramczyk, MD, PhD
Lips have important aesthetic and functional roles in the human body. First lip reconstruction was performed in 25 AD by a Roman surgeon who made relaxing incisions in the cheek to close defect of the lower lip. Modern surgical technics of lip reconstruction were developed in the mid-1800s, and basics principles have not changed significantly since then.
Lower lip malignant neoplasms should be treated aggressively and effect reconstruction depend on few things. Proper planning, fine instruments, proper suture material and experience of surgeons team are the most important factors in reconstructive treatment. In the case of lip cancer, where the surgeon provides excision more than 2/3 of the lip, it can use several different techniques to reconstruct the lips. One of these techniques is Gillies fan flap.
In the following article the authors presented a case of a 74-year-old man, Caucasian race, who was admitted to the hospital because of diagnosed lower lip carcinoma. The patient underwent surgery – wild excision of carcinoma and Gillies fan flap reconstruction. The patient was satisfied with reconstruction lower lip and aesthetic and functional effect of treatment was assessed by surgeons and patient as fully satisfying.
Lips have important aesthetic and functional roles in the human body. First lip reconstruction was performed in 25 AD by a Roman surgeon who made relaxing incisions in the cheek to close defect of the lower lip (1). Modern surgical technics of lip reconstruction were developed in the mid-1800s, and basics principles have not changed significantly since then (2, 3).
According to the National Cancer Registry, in Poland lips carcinomas are rare tumors, in men observed in 0.5% of cases and in women population in 0.1% of cases. The incidence of lip carcinoma in 2010 amounted to 420, of whom 318 in men and 92 in women. In Poland the incidence in men is about 5 times higher than in women. Most cancers lip occurs in the seventh-eighth decade of life and the risk of this cancer increases with age in both sexes. The number of deaths from lip carcinoma reported in 2010 to the National Cancer Registry in Poland was 105, of which 81 in men and 24 in women. Deaths in men were approximately 10 times more often than women. Most deaths from lip cancer occurs in the eighth decade of life and the risk of death due to this carcinoma increases with age in both sexes.
A 74-year-old man, Caucasian race, was admitted to the Department of Surgical Oncology because of diagnosed lower lip carcinoma (fig. 1, 2). In an interview with the patient, he informed us that tumor was present for 12 months and gradually expanded. The patient reported no pain in this area. Surgical biopsy before treatment showed squamous cell carcinoma.
Fig. 1. Lower lip carcinoma
Fig. 2. Squamous cell carcinoma of the lower lip
He had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was not treated for chronically diseases. Blood test and other routine hematological examinations and biochemical tests were within normal limits.
On physical examination, 3 cm of lower lip was infiltrated by carcinoma (fig. 1-3). There were not enlarged local lymph nodes. Also ultrasound examination of the neck lymph nodes did not show pathologically enlarged lymph nodes. Clinical lower lip carcinoma was – cT2N0M0.
Fig. 3. Cancer of the lower lip – marked marker excision margins
The patient was qualified for surgery. There was cut off tumor of the lower lip and the patient underwent Gillies fan flap reconstruction for freshly created lower lip defect (fig. 3-5). The duration of surgery was 90 minutes. Pathological examination showed squamous cell carcinoma G2. Patient after surgery felt good and did not complain of pain. The postoperative period was uncomplicated and the patient left the ward in the fourth day after operation. The patient is under control of outpatient surgical oncology. There was no observed recurrence of neoplasm disease for 6 months.
Fig. 4. Status after resection of the lower lip carcinoma during reconstruction the defect in the lower lip
Lip carcinoma is rare neoplasm responsible for the development of UV radiation, smoking, alcohol abuse, chronic herpes simplex virus infection and chronic diseases associated with immunosuppression (2, 3). The most frequent histopathological type of malignant lip neoplasm is squamous cell carcinoma. Cancer angle of the mouth and upper lip cancer have worse prognosis than cancer of the lower lip at a similar stage.
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1. Mazzola RF, Lupo G: Evolving concepts in lip reconstruction. Clin Plast Surg 1994; 11: 583-617. 2. Webster RC, Coffey RJ, Kelleher RE: Total and partial reconstruction of the lower lip with innervated muscle-bearing flaps. Plast Reconstr Surg 1960; 25: 360-371. 3. Goldstein MH: The elastic flap for lip repair. Plast Reconstr Surg 1990; 85: 446-452. 4. Sadove RC, Luce EA, McGrath PC: Resection of the lower lip and chin with the composite radial forearmpalmaris longus free flap. Plast Reconstruct Surg 1991; 88: 209-214. 5. Kuttenberger JJ, Hardt N: Results of a modified staircase technique for reconstruction of the lower lip. J Craniomaxillofac Surg 1997; 25: 239-244.