Introduction
Bite injuries of the lower lip are frequently encountered by plastic and reconstructive surgeons.Reference Rieck and Giesler1–Reference Bocci, Baccarani, Bianco, Castagnetti and Papadia4 Repairs can be performed in numerous ways.Reference Lebeau and Sadek5–Reference Rubin8 Based on previous experience, we present a case managed with an alternative reconstruction technique that utilised a linked mucosal flap comprising only the mucosal part of the lip. This method differs from those using a cutaneous plus mucosal flap, usually applied in combination because such injuries usually affect both cutaneous and mucosal tissue.Reference Jemec and Sanders9 Our approach was to apply a mucosal flap from the upper lip to the mucosal damage of the lower lip. This technique therefore ensured preservation of tissue quality, and also avoided scarring of the donor spot (desirable as mucosal scars are aesthetically much more acceptable).
Case report
A 35-year-old man suffered an injury to his lower lip after a human bite. The patient received antitetanus protection in the emergency room, and antibiotic prophylaxis was commenced using clindamycin (300 mg orally, thrice daily for two weeks). The injury to the lower lip measured 2.2 × 1.2 cm and spanned the left half of the lower lip, from the mid-line to the corner of the lip, which remained intact (Figure 1).
Fig. 1 Lower lip injury.
Reconstructive surgery was initiated six hours after the injury, after extensive cleaning of the wound. Surgery was performed under local anaesthesia (using lidocaine with adrenaline). Reconstruction employed a mucosal linked (two-stage) flap from the upper lip. The flap was elevated from the interior of the upper lip, with its stem set down towards the lip's free edge (i.e. distally). The flap was sutured in at the edges of the lower lip defect. We then sutured the donor site defect of the upper lip (Figure 2).
Fig. 2 Linked mucosal flap.
Three weeks after the first procedure, a second operation was performed in which the flap stem was resected. In the interval, the patient ate mainly liquids and mashed foods and thus lost 5.5 kg of body weight. The final results of surgery were both aesthetically and functionally excellent (Figure 3).
Fig. 3 Final result after flap stem resection.
Discussion
A range of flaps may be used for lip injury reconstruction. Here, we present one possibility, which is based on two principles. First, the mucosal flap applied to reconstruct the patient's lip injury was identical to the tissue type (i.e. mucosa) which needed to be covered. Second, this approach left the skin intact and therefore avoided any skin scarring, the healing of which is always unpredictable. Furthermore, mucosal healing results in much less scar tissue formation than does skin healing. On these bases, we recommend the use of this type of flap as a very successful method for reconstruction of certain lip injuries.
