Abstract: Vascular Anomalies of the Lip Challenge the Reconstructive Rule of Thirds (Plastic Surgery The Meeting)

Saturday, September 24, 2016: 9:00 AM

Daniel M Balkin, MD, PhD , Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, San Francisco, San Francisco, CA

Emily M Balkin, MD , Department of Pediatrics, University of California, San Francisco, San Francisco, CA

Rachel Lentz, MD , Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, San Francisco, San Francisco, CA

Erin F Mathes, MD , Departments of Dermatology & Pediatrics, University of California, San Francisco, San Francisco, CA

Ilona J Frieden, MD , Departments of Dermatology & Pediatrics, University of California, San Francisco, San Francisco, CA

William Y Hoffman, MD , Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, San Francisco, San Francisco, CA

Presentation PDF file

PURPOSE:
Vascular anomalies of the lip can cause aesthetic deformity and functional impairment. We characterized a cohort of patients requiring reconstructive surgery for vascular malformations of the lip.

METHODS:
Retrospective review of patients requiring reconstructive surgery for vascular malformations of the lip between 2005-2015.

RESULTS:
30 patients with vascular anomalies of the lip were identified. Female-to-male ratio was 1.5:1. Vascular malformations included hemangiomas (73.3%, 22/30), venous malformations (2/30), Sturge-Weber-related capillary malformations (2/3) or other (3/30). Median age at surgery was 5.6 years (range, 1.2-33.5). Indications for surgery included labial dysfunction (50%) and aesthetic deformity (93.3%). The lower lip was most frequently involved (80%, 24/30). In the lower lip, lateral lip lesions (66.7%, 16/24) were more common than central ones. The majority of lower lip resections involved the vermillion border (75%, 12/24), 58.3% (14/24) were full-thickness, 9/24 (64.3%) involved 1/3-2/3 total lip width and the remainder involved <1/3. In those patients with defects 1/3-2/3 total lip width, only 5/9 (56%) required local flap closure. Of upper lip anomalies (27%, 8/30), central lip lesions (75%) were more common than lateral ones, 50% of resections (4/8) involved the vermillion border, all (8/8) were partial thickness, and 87.5% (7/8) of upper lip reconstructions were achieved with primary closure. Postoperatively, 23.3% (7/30) of patients experienced minor issues with wound healing or infection. Median follow-up was 8.1 months (range, 3 days-8.4 years).

CONCLUSIONS:
Vascular malformations of the lips often require reconstructive surgery for both aesthetic and functional purposes. The lip reconstructive rule of thirds suggests that lower lip defects involving 1/3-2/3 total lip width require closure with lip switch or local advancement flap techniques.[1-3] However, our data demonstrate that many of such patients with large defects can be closed primarily. We posit that vascular malformations expand normal lip tissue enabling reconstruction by primary closure.

29736 Vascular Anomalies of the Lip Challenge the Reconstructive Rule of Thirds