40525 Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan)

Name of the Procedure:

Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan)

Summary

The excision of a lip with full-thickness tissue involves removing a portion of the lip, including skin, muscle, and mucosa. Following the removal, a local flap, such as the Estlander or fan flap, is used to reconstruct and repair the lip defect, ensuring both functionality and aesthetics are maintained.

Purpose

This procedure addresses conditions such as cancerous growths or severe trauma to the lip that require the removal of affected tissue. The goal is to remove unhealthy tissue while preserving lip function and appearance through immediate reconstruction.

Indications

• Presence of malignant or benign tumors on the lip.
• Significant trauma or injury to the lip.
• Congenital deformities requiring correction.
• Cases where other treatments have failed to address the issue.

Preparation

• Patients may be advised to fast for several hours prior to surgery.
• Medication adjustments may be necessary, particularly for blood-thinning drugs.
• Pre-operative assessments including blood tests, imaging, and a thorough physical examination.
• Discussion of medical history and any allergies is crucial.

Procedure Description

1. Anesthesia: The procedure begins with administering local or general anesthesia to ensure patient comfort.
2. Excision: The surgeon carefully removes the affected portion of the lip in a full-thickness manner.
3. Reconstruction: A local flap, such as the Estlander flap (which rotates a portion of the lip from the adjacent area) or a fan flap, is designed and moved into place to fill the defect.
4. Suturing: The flap is meticulously sutured to ensure proper healing and minimal scarring.
5. Final Assessment: The surgeon assesses the reconstructed area for functionality and aesthetic alignment.

Duration

The procedure typically takes 1 to 3 hours, depending on the extent of tissue removal and complexity of the reconstruction.

Setting

This surgery is usually performed in a hospital operating room or a specialized outpatient surgical center.

Personnel

• A board-certified plastic or reconstructive surgeon.
• An anesthesiologist or nurse anesthetist.
• Surgical nurses and operating room technicians.

Risks and Complications

• Common risks: Infection, bleeding, and temporary numbness.
• Less common risks: Flap failure, excessive scarring, asymmetry, and functional deficits.
• Management typically involves antibiotics for infection, careful monitoring, and potentially additional surgeries for flap issues.

Benefits

• Removal of unhealthy or cancerous tissue.
• Restoration of lip function (eating, speaking, facial expressions).
• Enhanced aesthetic outcome, improving patient confidence.
• Benefits are often realized shortly after recovery but may continue to improve over several months.

Recovery

• Post-operative care includes wound care, pain management, and activity restrictions.
• Patients may require a soft or liquid diet initially.
• Recovery time ranges from 2 to 4 weeks, depending on individual healing and extent of surgery.
• Follow-up appointments are essential to monitor healing and address any complications.

Alternatives

• Non-surgical options: Radiation therapy or chemotherapy for cancerous lesions.
• Other surgical options: Primary closure without flap (suitable for smaller defects), skin grafts, or more advanced flap techniques like the Karapandzic flap.
• Pros and Cons: Non-surgical options may be less invasive but less effective for large or deeply invasive tumors. Other surgical options may offer different aesthetic outcomes or recovery times.

Patient Experience

• During the procedure: Patients will not feel pain due to anesthesia but may feel pressure or movement.
• After the procedure: Mild to moderate pain, manageable with prescribed pain relief. Swelling and bruising are common.
• Pain management: Pain relief medications and cold compresses. Sustained comfort is managed with ongoing pain assessment and intervention as needed.