title: The reconstruction of two large full-thickness wounds of the upper lip with different operative techniques: when possible, a local flap repair is preferable to reconstruction with free tissue transfer.
abstract: BACKGROUND
  Large full-thickness wounds of the upper lip are often referred to operating room-based surgeons for repair given the perceived difficulties in restoring upper lip form and function with simpler operative techniques.
  
  
  OBJECTIVE
  To illustrate the functional, aesthetic, and cost differences between two techniques used to repair full-thickness wounds of the upper lip.
  
  
  METHODS
  Two patients with difficult full-thickness wounds of the majority of the upper lip were reviewed. One patient underwent reconstruction with a composite free flap in an operating room, and one underwent repair using local tissue rearrangement using bilateral modified nasolabial flaps in an outpatient setting.
  
  
  RESULTS
  Both patients were adequately reconstructed, but the patient repaired using local tissue rearrangement had a better aesthetic outcome and superior preservation of oral competency. In addition, the costs of this patient's reconstructive care were less than 2.4% of the costs of the care of the patient repaired using a free flap.
  
  
  CONCLUSIONS
  When possible, large, full-thickness wounds of the upper lip should be repaired with local tissue rearrangement in an outpatient setting to offer patients potential improvements in functional and aesthetic outcomes while minimizing treatment costs.
authors.affiliation: Department of Dermatology, Duke University Medical Center, Durham, North Carolina 27710, USA. Jonathan.Cook@duke.edu
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Cook
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery*; D004954:Esthetics; D006801:Humans; D008048:Lip Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome