Use of triangular closure procedure for reconstruction of large lower lip defects and postoperative functional assessment

Providing an aesthetically and functionally satisfactory result in reconstruction of lower lip defects is still a difficult task for reconstructive surgeons. Here, we present the use of triangular closure technique as a new approach to improve the quality of reconstruction in patients with lower lip defects. In this technique, two flaps obtained with an unequal z-plasty are used. The first flap is a myocutaneous one including the depressor anguli oris muscle while the second flap is a pure cutaneous flap. The lip defect is repaired via transposition of myocutaneous flap to the defect area, while the cutaneous flap is used for closure of its donor site. The oral sphincter is reconstructed by suturing the depressor anguli oris muscle to the orbicularis oris muscle. Mucosal coverage is provided with a mucosal flap obtained from the upper buccal area. Over 5 years, this procedure was used for reconstruction of large defects of the lower lip in 32 patients. The outcome was cosmetically and functionally acceptable for all patients and comparing with the other techniques in the literature, our technique is found better. Physical examination and electromyographical studies revealed an intact oral sphincter and normal lip sensitivity. During a mean follow-up period of 34 months, except one patient, there was no patient with tumor recurrence. There was no patient with microstomy. This procedure seems to be a useful alternative to provide a better aesthetic and functional outcome in reconstruction of the lower lip defects.