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• W1142261217 abstract "Sir: We read with great interest the article entitled “Surgical Treatment and Reconstruction of Nonmelanoma Facial Skin Cancers” by Dr. Rogers-Vizena et al.1 In the article, several reconstructive options for facial defects were carefully described by anatomical location. In facial plastic surgery procedures, it is mandatory to preserve facial aesthetic units and subunits to avoid asymmetry and distortions. To reach this important goal, anatomical boundaries should be respected, with any surgical incision or excision performed within or parallel to the relaxed skin-tension lines. This allows a tension-free cicatrization process and helps to improve the cosmetic result. One of the most important aesthetic subunits of the face, both cosmetically and functionally, is the upper lip. It extends from the base of the nose superiorly to the nasolabial folds laterally and to the free edge of the vermilion border inferiorly; it is located in the middle of the face and has considerable significance regarding appearance and expression. Wrong reconstruction might result in deformity of the laugh line and will be easily noticed. In older individuals with excess skin, primary closure is preferred to cover a nonexcessive defect. In younger individuals, in whom there is tightness of the skin or defects that are too large, the closure will be effected through the use of transposition, rotation, island, or even bilobed flaps. In the article, the authors stated that nasolabial flaps are particularly well suited for subunit reconstruction of the ala and the lateral part of the upper lip; however, the tradeoff is donor-site morbidity. In fact, reconstruction through this type of flap often results in medial cheek and melolabial fold contour asymmetry.1 In our experience, we could avoid a poor aesthetic result using a “jigsaw-puzzle” flap. The use of this local flap has already been described for repairing lateral nasal ala defects and for reconstruction of retroauricular surgical defects.2,3 To integrate the surgical reconstructive options presented in the article by Dr. Rogers-Vizena et al.,1 we would like to present a case where we used the jigsaw-puzzle flap to reconstruct a lateral upper lip defect. The flap was used to repair a defect of the right lateral upper lip after basal cell carcinoma resection. Tumor size was 12 × 12 mm; the lesion was excised, with security margins determined by dermoscopy. The final surgical defect size was 15 × 18 mm. Burow triangles were excised parallel to the nasolabial line, and the flap was transposed medially to cover the defect (Fig. 1). The flap was anchored using 5-0 subcutaneous absorbable sutures, and the final cutaneous closure was performed with running 5-0 nylon sutures.Fig. 1: Jigsaw puzzle advancement flap for reconstruction of the lateral upper lip defect.This flap allowed the use of cheek skin to cover a lateral labial defect with minimal disfiguring of the laugh line, in a single-stage operation. Eight weeks after surgery, this subcutaneous advancement flap provided good functional and aesthetically acceptable reconstruction. With the jigsaw puzzle advancement flap, excess skin and subcutaneous fat from the cheek can be easily moved into lateral upper lip defects, with good functional and aesthetically acceptable results. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Amgiad Fallaha, M.D. Franco Perino, M.D. Klaus Eisendle, M.D. Department of Dermatology Hospital of Bolzano Bolzano, Italy Andrea Sisti, M.D. Juri Tassinari, M.D. General and Specialist Surgery Department Plastic Surgery Division University of Siena Siena, Italy Francesco Idone, M.D. Jalisco Plastic and Reconstructive Institute University of Guadalajara Guadalajara, Jalisco, México Giuseppe Nisi, M.D. General and Specialist Surgery Department University of Siena Siena, Italy" @default.
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• W1142261217 date "2015-12-01" @default.
• W1142261217 modified "2023-09-26" @default.
• W1142261217 title "Local Flap for Reconstruction of Nonmelanoma Facial Skin Cancer" @default.
• W1142261217 doi "https://doi.org/10.1097/prs.0000000000001780" @default.
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