Examqo › Examqo library › Plastic surgery › Reconstruction
Lip reconstruction
Lip reconstruction is chosen by how much is missing: up to a third of the lip — primary closure by wedge excision; a third to two thirds — a flap from the opposite lip (Abbe or Estlander) or Karapandzic; over two thirds — cheek flaps or a free flap; and in every method the vermilion border is aligned first and the orbicularis muscle restored.
Why it matters in the exam
Lower lip cancer is usually squamous cell carcinoma (sun exposure, smoking), and upper lip cancer is often BCC. Actinic cheilitis is treated by vermilionectomy and mucosal advancement. The Abbe flap is a "lip-switch" flap on the labial artery, used mainly for a defect in the centre of the upper lip (philtrum), and divided after 2 to 3 weeks; Estlander suits a defect involving the oral commissure, but leaves a rounded commissure. Karapandzic rotates the remaining lip around the mouth and preserves muscle innervation and sensation, so function is good — but it reduces the mouth opening (microstomia). For very large defects: Gillies fan, Bernard-Burow (Webster), or a free radial forearm flap with the palmaris tendon for suspension.
Principles: mark the vermilion border (white roll) before injecting local anaesthetic, because adrenaline blanches and blurs it — a 1 mm error shows from a distance; close in three layers — mucosa, muscle and skin; and restore muscle continuity to prevent drooling. In a central upper lip defect the philtrum is kept as a unit and cheek is not advanced into it, to avoid distorting it. In the upper lip, where the cheeks are more mobile, a larger defect can sometimes be closed than in the lower lip. When a lower lip tumour is large or nodes are present, neck node work-up and sometimes dissection are added.
Key points
- Up to a third — primary closure.
- Abbe — centre of the upper lip, two stages.
- Estlander — the commissure.
- Karapandzic — innervation preserved, microstomia.
- Vermilion marked before anaesthesia; three layers.
Summary table
| Defect size | Method | Advantage | Drawback |
|---|---|---|---|
| Up to a third | Wedge excision and primary closure | Simple, full function | — |
| A third to two thirds, central upper | Abbe | Restores the philtrum | Two stages, divided after 2 to 3 weeks |
| A third to two thirds, including the commissure | Estlander | Single stage | Rounded commissure |
| A third to two thirds, lower | Karapandzic | Preserves innervation and sensation | Microstomia |
| Over two thirds | Gillies fan, Bernard-Burow, free radial forearm | Covers large defects | Microstomia, lip without full function |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Plastic surgery, ENT and head and neck surgery, Dermatology and venereology.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- Plastic Surgery (Neligan), 5th edition (2023) — Reconstruction of the lips
- Grabb and Smith's Plastic Surgery, 8th edition (2019) — Lip reconstruction
- NCCN Guidelines: Squamous Cell Skin Cancer, 2025 — Lip and high-risk sites
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.