Double-paddle peroneal flap for extensive lip defect reconstruction.
BACKGROUND
Today, reconstructive surgeons offer an array of options to reconstruct the lip defects. Herein we present our experience of using free double-paddle peroneal flaps for extensive lip defect reconstruction.


METHODS
From 1996 to 2014, 16 patients with extensive lip defects after tumor ablation were included. Free double-paddle peroneal flaps were used for reconstructions. In terms of flap design, one skin paddle superiorly placed on the lateral lower leg was used to reconstruct intraoral defects, whereas the other was inferiorly located and was used to reconstruct extraoral defects. A part of the inner skin paddle was everted, and the suture line with the outer skin paddle became the new vermilion border. A portion of the outer skin paddle could be de-epithelized and tucked into the fold of the inner skin paddle, leading to greater fullness of the new lip.


RESULTS
Skin paddle sizes were 10-15 cm × 3-13 cm and 4-10.5 cm × 2.5-10.5 cm. Venous thrombosis occurred in one patient but was salvaged, and one flap had superficial necrosis over the outer paddle that was conservatively treated. In the 0.5-33 month follow-up period, all patients were able to close their mouths without obvious drooling.


CONCLUSIONS
Free double-paddle peroneal flap transfer could augment lip definition, deepen the labial vestibule, and provide an acute-angle oral commissure, leading to satisfactory oral competency and improved cosmetic results. Therefore, this technique may be considered a viable option for extensive lip defect reconstruction.
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ying-Sheng
YS
Lin
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|National Defense Medical Center, Taipei, Taiwan.
Wen-Chung
WC
Liu
National Defense Medical Center, Taipei, Taiwan.|Department of Otolaryngology Head and Neck, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Yaoh-Shiang
YS
Lin
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Lee-Wei
LW
Chen
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Jung-Hua
JH
Hsueh
Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|National Defense Medical Center, Taipei, Taiwan.
Kuo-Chung
KC
Yang
D000368:Aged; D002607:Charcot-Marie-Tooth Disease; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D008048:Lip Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation; D014945:Wound Healing / Q000502:physiology*