(406) Dynamic Reconstruction of Subtotal Upper Lip Defect with Local Flaps

Introduction: A three-layer reconstruction of gingival mucosa, levator labii superioris, and bilateral nasolabial fold flaps was utilized in this case report of upper lip Mohs reconstruction. Patient demonstrated good recovery as demonstrated by ability to drink through a straw and pucker lips as well as ability to eat normal bites of food without microstomia.

Methods: A single case of a patient undergoing Mohs reconstruction after cancer in 2024 at an academic medical center in Oklahoma, USA. This patient received reconstruction for a subtotal through-and- through upper lip defect sparing only the bilateral commissures. Outcomes were determined by both appearance and functionality.

Results: A multi-layered closure was performed with local flaps. Bilateral buccal advancement flaps were used to repair the internal mucosa layer. The bilateral levator labii superioris was dis-inserted from the orbital rim while maintaining its neural supply and rotated horizontally to replace the orbicularis oris muscle. Bilateral opposing nasolabial flaps were then rotated to repair the skin deficit. Postoperatively, the patient regained the ability to pucker and drink from a straw, and had no difficulties with eating secondary to microstomia.

Conclusions: In select patients with large upper lip defects, a multi-layered local flap repair can be considered for dynamic Mohs reconstruction as well as to minimize microstomia.