title: Bilateral musculocutaneous unequal-Z procedure: a new technique for reconstruction of total lower-lip defects.
abstract: BACKGROUND
  Although several techniques have been described for total lower-lip reconstruction, it is still a major reconstructive challenge, which often requires lengthy and risky microsurgical procedures.
  
  
  OBJECTIVE
  Here, we present a new local procedure, namely, bilateral musculocutaneous unequal-Z procedure for functional reconstruction of total lower-lip defects.
  
  
  METHODS
  In this technique, 2 musculocutaneous flaps including the depressor anguli oris and platysma muscles, respectively, are used in an unequal Z-plasty manner on each side of the defect. The lip defect is closed by the means of extra tissue relaxation provided with bilateral Z-plasty maneuver. The oral sphincter is reconstructed by suturing the depressor anguli oris muscles to each other at the midline. The mucosal coverage is provided with mucosal flaps obtained from the buccal areas bilaterally. Over 2 1/2 years, this new technique was used in 8 patients, aged between 47 and 83 years, with total lower-lip defects resulted from excision of squamous cell carcinomas.
  
  
  RESULTS
  All patients healed uneventfully. At 6 months, physical and electromyography (EMG) examinations revealed an intact oral sphincter with a normal sensitivity. One patient died because of lung metastasis at 8 months after surgery. A mean follow-up of 2 years revealed a functionally and cosmetically acceptable lower-lip reconstruction in all surviving patients.
  
  
  CONCLUSIONS
  As a nonmicrosurgical local procedure providing an esthetically acceptable, sensitive, and functional lower lip, this new technique seems to be a useful alternative to the microsurgical procedures in total lower-lip reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey. doctormutaf@yahoo.aom
authors.forename: Mehmet
authors.initials: M
authors.lastname: Mutaf
authors.forename: Omer
authors.initials: O
authors.lastname: Bulut
authors.forename: Mahmut
authors.initials: M
authors.lastname: Sunay
authors.forename: Aslý
authors.initials: A
authors.lastname: Can
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002680:Chin / Q000601:surgery; D004576:Electromyography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008046:Lip / Q000601:surgery*; D008048:Lip Neoplasms / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques