10.14639/0392-100X-N1458
Objective. Reconstruction of the lower lip is complex. The Colmenero flap is an effective albeit rarely described method for the repair of medium- to large-sized defects of the lower lip. Methods. A retrospective review was carried out using data gathered from patients who had undergone Colmenero flap reconstruction of the lower lip at our centre between 2015 and 2020. We analysed demographic, histologic and anatomic variables as well as surgical results. This review assessed flap functionality based on proper mouth closure, absence of microstomia and oral competence. Results. Thirteen Colmenero flaps were performed in 9 patients, with the flap being used bilaterally in four cases. All patients had squamous cell carcinoma of the lower lip. The mean length of the reconstructed defect was 4.1 cm (ranging between 3-7.5 cm). None of the flaps exhibited signs of necrosis. Five patients required minor surgical touch up during the second procedure: two for dehiscence, two for oral leakage and one for esthetic improvement. All patients had excellent functional and aesthetic final outcomes. Conclusions. The Colmenero flap is a good resource for medium- and large-sized lower lip reconstructions due to its reliability, limited complications, and good aesthetic and functional results.
text/xml
1827-675X
1458
en
Rosa-Delia Ramirez-Ruiz
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
sentinel node
Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option
Text.Serial.Journal
https://www.actaitalica.it/
41
Head and neck
2021-11-26
2021-02-04
2021-12-22
2021-12-22
507-513
1
Rosa-Delia Ramirez-Ruiz
2021/11/26
10.14639/0392-100X-N1458
507
Department of Otorhinolaryngology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
1827-675X
sentinel node
513
Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option
https://www.actaitalica.it/article/download/1458/703
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:507-513; doi: 10.14639/0392-100X-N1458




Head and neck


Reconstruction of the lower lip after broad oncologic
resection by Colmenero flap: a reliable option
Ricostruzione del labbro inferiore mediante lembo di Colmenero dopo ampia chirurgia
demolitiva: una opzione affidabile
José-Miguel Costa-Gonzalez1, Anna Sumarroca2, Jordi Aguilera-Saez3, María Martel-Martin4, Andreas Leidinger5,
María-Pilar Machin6, Rosa-Delia Ramirez-Ruiz1
1
  Department of Otorhinolaryngology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; 2 Department
of Otorhinolaryngology, Hospital del Mar – Parc de Salut Mar de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain;
3
  Department of Plastic Surgery and Burns, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona,
Spain; 4 Department of Otorhinolaryngology, Hospital Sant Joan Despí Moisès Broggi, Universitat de Barcelona, Barcelona, Spain;
5
  Department of Neurosurgery, Hospital Mútua de Terrassa, Universitat de Barcelona, Barcelona, Spain; 6 Anatomical Pathology
Department, Hospital de Sant Joan Despí Moisès Broggi, Universitat de Barcelona, Barcelona, Spain


SUMMARY
Objective. Reconstruction of the lower lip is complex. The Colmenero flap is an effective
albeit rarely described method for the repair of medium- to large-sized defects of the lower
lip.
Methods. A retrospective review was carried out using data gathered from patients who            Received: February 4, 2021
had undergone Colmenero flap reconstruction of the lower lip at our centre between 2015          Accepted: March 26, 2021
and 2020. We analysed demographic, histologic and anatomic variables as well as surgical         Published online: November 26, 2021
results. This review assessed flap functionality based on proper mouth closure, absence of
microstomia and oral competence.                                                                 Correspondence
Results. Thirteen Colmenero flaps were performed in 9 patients, with the flap being used         Anna Sumarroca
bilaterally in four cases. All patients had squamous cell carcinoma of the lower lip. The        Department of Otorhinolaryngology, Hospital del
mean length of the reconstructed defect was 4.1 cm (ranging between 3-7.5 cm). None of           Mar – Parc de Salut Mar de Barcelona, Universitat
the flaps exhibited signs of necrosis. Five patients required minor surgical touch up during     Pompeu Fabra, Passeig Marítim de la Barceloneta,
                                                                                                 25, 29, 08003 Barcelona, Spain
the second procedure: two for dehiscence, two for oral leakage and one for esthetic im-
                                                                                                 Tel. +34 932 48 30 00. Fax +34 932 48 32 54
provement. All patients had excellent functional and aesthetic final outcomes.                   E-mail: annasumarroca@gmail.com
Conclusions. The Colmenero flap is a good resource for medium- and large-sized lower lip
reconstructions due to its reliability, limited complications, and good aesthetic and func-      Funding
tional results.                                                                                  None.
KEY WORDS: Colmenero flap, lower lip reconstruction, lip carcinoma, squamous cell
carcinoma, sentinel node                                                                         Conflict of interest
                                                                                                 The Authors declare no conflict of interest.

RIASSUNTO
                                                                                                   How to cite this article: Costa-Gonzalez JM,
Obiettivo. La ricostruzione del labbro inferiore è complessa. Il lembo di Colmenero è un
                                                                                                   Sumarroca A, Aguilera-Saez J, et al. Reconstruc-
metodo efficace anche se raramente descritto per la riparazione di difetti medio-grandi del        tion of the lower lip after broad oncologic resec-
labbro inferiore.                                                                                  tion by Colmenero flap: a reliable option. Acta
Metodi. È stata effettuata una revisione retrospettiva utilizzando i dati raccolti da pazienti     Otorhinolaryngol Ital 2021;41:507-513. https://
sottoposti a ricostruzione del labbro inferiore mediante lembo di Colmenero presso il no-          doi.org/10.14639/0392-100X-N1458
stro centro tra il 2015 e il 2020. Abbiamo analizzato le variabili demografiche, istologiche
e anatomiche nonché i risultati chirurgici ottenuti. Questa revisione ha valutato la funzio-     © Società Italiana di Otorinolaringoiatria
nalità del lembo in base alla corretta chiusura della bocca, all’assenza di microstomia e        e Chirurgia Cervico-Facciale
ripristino della competenza orale.
Risultati. Tredici lembi di Colmenero sono stati eseguiti in 9 pazienti, in quattro dei quali                   OPEN ACCESS
bilateramente. Tutti i pazienti erano affetti da carcinoma a cellule squamose del labbro in-     This is an open access article distributed in accordance with
feriore. La lunghezza media del difetto ricostruito è risultata di 4,1 cm (compresa tra 3-7,5    the CC-BY-NC-ND (Creative Commons Attribution-Non-
cm). Nessuno dei lembi ha manifestato segni di necrosi. Cinque pazienti hanno richiesto          Commercial-NoDerivatives 4.0 International) license. The
                                                                                                 article can be used by giving appropriate credit and mentio-
piccoli ritocchi chirurgici mediante una seconda procedura: due per deiscenza, due per           ning the license, but only for non-commercial purposes and
incontinenza orale e uno per miglioramento estetico. Tutti i pazienti hanno avuto ottimi         only in the original version. For further information: https://
risultati finali funzionali ed estetici.                                                         creativecommons.org/licenses/by-nc-nd/4.0/deed.en




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J.M. Costa-Gonzalez et al.




Conclusioni. Il lembo Colmenero è una buona risorsa per ricostruzioni del labbro inferiore di medie e grandi dimensioni grazie alla sua affi-
dabilità, alle modeste complicazioni e ai buoni risultati estetici e funzionali.
PAROLE CHIAVE: lembo di Colmenero, ricostruzione del labbro inferiore, carcinoma del labbro, carcinoma a cellule squamose, linfonodo
sentinella



Introduction                                                            procedures were performed by the same surgical team. This
                                                                        study was carried out in accordance with the Declaration
The lower lip performs various functions, such as ensur-
                                                                        of Helsinki.
ing proper mouth closure during swallowing, oral compe-
tence for saliva containment, speech, facial mimicry and
                                                                        Oncologic management
aesthetic harmony 1. Squamous cell carcinoma is the most
                                                                        The overall oncologic management (surgical indication
common malignancy of the lower lip 2. Its prognosis de-
                                                                        and lymph nodes management) of patients was individu-
pends on the tumour size, degree of invasion 3 and lymph
                                                                        alised and agreed by the Functional Oncology Care Unit.
node involvement 2, and its treatment is mainly surgical 4.
                                                                        The results of histopathology for all lesions corresponded
There are many reconstructive options after excision of tu-
                                                                        to infiltrating squamous cell carcinomas of the lower lip
mours of the lower lip, and their use depends on the size,
                                                                        was performed, and were classified or reclassified accord-
location and type of defect. Smaller lesions (less than one
                                                                        ing to the 8th Edition of the TNM 3. The tumour excision
third of the lip) can be resolved with direct closure after
                                                                        was performed with macroscopic margins of 1 cm. The pa-
wedge excision 5, while larger defects (affecting the entire
                                                                        tients with suspected regional lymph node involvement and
lip, including the vermilion) can be reconstructed using a
                                                                        those with cT3 tumours underwent simultaneous homolat-
free flap 1. Medium- and large-sized defects, involving be-
                                                                        eral or bilateral functional cervical lymph node dissection,
tween one-third and the entire lower lip, can be repaired
                                                                        depending on the location of the primary tumour and the
with pedicled local flaps, such as the Abbe flap 6, the Kara-
                                                                        results of imaging tests. Patients with cT1N0 or cT2N0 tu-
pandzic flap 7, the flap designed by Yu 8, or the gate flap
                                                                        mors underwent sentinel node detection in the same sur-
described by Fujimori 9. The Colmenero flap 10, first de-
                                                                        gical procedure. The cases which, after histopathological
scribed in 1981 and named after its creator, is a local trans-
                                                                        assessment, were classified as pT3 or in which the sentinel
position flap that is pedicled to the inferior labial artery.
Although there has been little documentation of this flap, it           node testing revealed positive results, underwent a second
has been reported to be a useful method to repair medium-               cervical lymph node dissection. In one cT2 patient, the sen-
and large-sized lower lip defects due to its ease of use, use           tinel lymph node was not detected due to very extensive an-
of defect-like tissue, reliability and the possibility to create        terior cervical lipomatosis, and the surgical treatment was
a neo-vermilion.                                                        not decided until the final histopathological results of the
The objective of this study was to document our series of               tumour (pT2) became available. The second case, which
reconstructions of the lower lip after tumour resection us-             was first classified as cT2N0 and reclassified after resection
ing the Colmenero flap, thereby providing an update of its              and assessment of the sentinel node as pT3N3b (due to cap-
indications, surgical technique and aesthetic and functional            sular rupture), refused cervical treatment and was closely
results achieved, as well as its complications and suggested            monitored by clinical and imaging exams. None of the pa-
resolutions.                                                            tients received chemotherapy or adjuvant radiation therapy.

                                                                        Surgical technique
Materials and methods                                                   The accepted surgical technique at our Unit is as follows:
A retrospective review was carried out in patients who had              first, a complete “V” wedge excision of the primary lip
undergone lower lip resection and Colmenero flap recon-                 lesion is performed, with macroscopic margins of 1 cm
struction at our centre between 2015 and 2020. We col-                  (Fig. 1 A-B). Secondly, the diameter of the defect is meas-
lected data from the registry of patients with head and neck            ured and the flap is designed. The donor area is usually ho-
tumours treated at our hospital during admission and out-               molateral for defects of less than two-thirds of the lower
patient follow up. Gender, age, smoking history, cTNM and               lip, and bilateral for defects greater than two-thirds of the
pTNM classification, defect size, treatments performed,                 lower lip or for very central defects, to improve postopera-
complications, reoperations, final result and follow-up time            tive facial symmetry. The flap design is full thickness, in-
were analysed. The follow-up time was measured from the                 cluding skin, muscle and mucosa. The first incision begins
date of the surgery to the date of the last visit. All surgical         at the corner of the lip and is proportional to the length of



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Figure 1. Design of the Colmenero flap. (A) Diagram of the flap design. The          Figure 2. Creation and tailoring of the flap. (A) Diagram of the tailoring and
discontinuous line reflects the need to cut the jugal mucosa 1 cm higher than        blood supply of the flap. The flap depends mainly on the inferior labial artery,
the cut of the skin to revert the mucosa and facilitate creation of the neo-ver-     which is a branch of the facial artery (on the right). It is supplied secondarily
milion. The design should allow the integrity of the Stensen duct papilla (circle)   by another arterial tributary from the submental artery, which is more medial
in the mucosa to be maintained. (B) Photograph of the design of tumour resec-        and inferior. Source: A. Leidinger. (B) Photograph of the tailoring of the bilateral
tion and design of the bilateral Colmenero flap.                                     flap to the defect. The pedicles are located and preserved with Vaseloops®.


the defect. The second incision starts at the distal point of                        pedicles are identified, dissection of the flap edges to the
the first incision, and continues down towards the mandibu-                          mucosa is completed. Subsequently, the upper incision is
lar bar, without reaching it. At the lower end of the second                         transfixed by cutting the mucosa 1 cm higher than the skin
incision, a Z-plasty is designed to facilitate tension-free                          incision, in order to be able to reverse it to the outside and,
closure of the donor area.                                                           thereby, serve as a neo-vermilion. The inferior Z-plasty can
Once the skin cuts are made, a blunt dissection is performed                         be performed with or without preservation of the mucosa.
until the main arteriovenous pedicles of the flap are located                        Third, the flap is rotated and tailored to fit the defect and the
and preserved. The main flap vascular supply depends pri-                            closure (Fig. 3 A-B). It is possible to perform an island flap,
marily on the inferior labial artery – a branch of the facial                        leaving it attached by the vascular pedicle only, which al-
artery – and secondarily on the submental artery (Fig. 2A).                          lows better mobilisation and more precise repositioning of
The inferior labial artery is located 2.58 cm (SD 0.70) and                          the flap. In one patient, the procedure yielded good results
1.54 cm (SD 0.45) inferior to the lip commissure. It trav-                           (Fig. 4). To provide greater functionality to the lower lip,
erses between the muscular and glandular layers of the lip,                          a muscle band is removed from the upper lip (Fig. 5 A-B)
about 8 mm parallel to the free edge of the lower lip 11.                            and inserted into the submucosa of the lower lip. Finally, all
The concomitant arteries and veins are located and pro-                              wounds were sutured in three layers: interrupted stitches of
tected with Vaseloops® for added safety (Fig. 2B). Once the                          resorbable material (Vycril® 3-0) were used for the mucosa



                                                                                                                                                                   509
J.M. Costa-Gonzalez et al.




                                                                                 Figure 4. Result of the Colmenero flap made on an island.

Figure 3. The final outcome of the lower lip reconstruction. (A) The final de-
sign of the reconstructed lip. Source: A. Leidinger. (B) Photograph of the pa-
tient’s lip at six months after the surgery.                                     previous history of use of tobacco at the time of diagnosis.
                                                                                 One patient was staged pT1, five patients were staged pT2
                                                                                 and three patients were staged pT3. The mean length of the
and submucosa, and single stitches of monofilament thread                        defect created in the lip by the excision of the tumour lesion
(Prolene® 4-0) were used for the skin. Cutaneous healing                         was 4.1 cm (ranging between 3-7.5 cm). In four patients,
can be optimised with epithelialisation ointment.                                the flaps were performed bilaterally as part of the same sur-
The anatomic course of the inferior labial artery is fairly                      gical procedure; thus, a total of 13 Colmenero flaps were
constant, and thus we perform this flap guided by anatomic                       used: 7 on the right side and 6 on the left. During follow-
landmarks. Nevertheless, the use of preoperative vascular                        up, no cases of local, regional, or distant tumour recurrence
study with Doppler ultrasound could provide more reliabil-                       were observed. Table I summarises these results.
ity and safety. We acknowledge its utility especially during
the early cases of a surgeon’s learning curve.                                   Flap viability
                                                                                 All Colmenero-type flaps were viable and were performed
Results                                                                          in a single surgical procedure; no partial or total necrosis
                                                                                 was observed in any patient. The inferior labial artery could
Patient characteristics                                                          be identified in all cases, in addition to other secondary
Nine patients were operated on, which included seven men                         pedicles. All flaps fulfilled their reconstructive function.
and two women, with a mean age of 77 years (ranging                              Four patients required bilateral flaps due to the large size
between 71-88 years). The mean follow-up time was 30                             and central location of the defect. The facial artery was pre-
months (range 6-70 months). Eight of the nine patients had                       served during cervical lymph node dissection.



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                                                                                                           Reconstruction of the lower lip by Colmenero flap




                                                                                     hiscence in the midline suture between both Colmenero
                                                                                     flaps. The second patient presented a surgical dehiscence at
                                                                                     the area of the flap suture, with the medial end of the lower
                                                                                     lip preserved. On both occasions, the defect was resolved
                                                                                     by refreshing the margins and suture under local anaesthe-
                                                                                     sia in the outpatient clinic, 20 days after the surgery in the
                                                                                     first case and one month after the surgery in the second
                                                                                     case. Both patients healed well, with no new dehiscence
                                                                                     being observed.
                                                                                     Lip incompetence that translated into fluid leakage while
                                                                                     drinking was observed in two patients who consequently
                                                                                     required surgical correction under local anaesthesia in the
                                                                                     operating room. In one case, the flap was unilateral and
                                                                                     the leakage was corrected, with improved lip closure at 20
                                                                                     months after the first surgery. Placement of a muscular up-
                                                                                     per lip band in the submucosa of the lower lip was repeated.
                                                                                     In the second case, operated with bilateral flaps, the mu-
                                                                                     cosa suture area was retouched with a Z-plasty to decrease
                                                                                     the tension exerted by retractable flanges. Both patients
                                                                                     achieved complete lip competence after healing.
                                                                                     On one patient, surgical procedure was performed two
                                                                                     times because he was histopathologically recategorised as
                                                                                     pT3N0. During the second time, the patient underwent cer-
                                                                                     vical lymph node dissection and an aesthetic lip touch-up,
                                                                                     reducing a redundant fold of neolabial mucosa.
                                                                                     None of the flaps or cervical surgeries required urgent sur-
                                                                                     gical revision, nor did they result in any major complica-
Figure 5. Placement of an upper lip muscle band for the lower lip. (A) Pho-          tions.
tograph of the surgical muscle band technique. (B) Photograph of the patient’s
lip at six months after the surgery.
                                                                                     Functionality and aesthetics
                                                                                     The functionality of the flaps was assessed based on three
Complications                                                                        items: correct mouth closure, absence of a microstomia
Four of the 9 operated patients presented minor complica-                            based on the ability to eat with normal eating utensils and
tions; however, they were all readily rectified. Two patients                        oral competence with the absence of fluid leakage while
presented with surgical wound dehiscence. The first patient                          drinking. These aspects were reviewed during follow-up,
had undergone bilateral treatment and presented with de-                             and the flaps were found to have excellent functionality in


Table I. Characteristics of patients treated with a Colmenero flap.
 Patient         pTNM              Unilateral/           Lower lip          Complications          Retouching       Final competence        Follow-up
                                    bilateral           percentage                                                  and functionality    period (months)
                                                         sacrificed
 1                  T2N0            Bilateral              90%                   Dehiscence         Friedrich              Yes                  70
 2                  T2N0            Unilateral             75%                    Leakage           Lip band               Yes                  52
 3                  T3N0            Bilateral              60%                       No             Aesthetic              Yes                  50
 4                  T2N0            Bilateral              75%                    Leakage           Z-plasty               Yes                  34
 5                  T1N0            Unilateral             50%                       No                No                  Yes                  30
 6                  T2N0            Unilateral             60%                   Dehiscence         Friedrich              Yes                  13
 7                 T3N3b            Unilateral             60%                       No                No                  Yes                  12
 8                 T2N0             Unilateral             50%                       No                No                  Yes                  7
 9                 T3N0             Bilateral              90%                       No                No                  Yes                  6




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J.M. Costa-Gonzalez et al.




all cases. All patients maintained proper lip mobility that       tionality being limited due to the resulting microstomia. In
allowed them to blow and fully close their mouths. None of        contrast, free flap microanastomosis is the preferred option
the cases exhibited microstomies or mouth opening prob-           for reconstruction of the entire lip, including the vermil-
lems stemming from the lip reconstruction. In addition,           ion 1, because it provides a greater contribution of tissue.
none of the patients were found to exhibit fluid leakage or       The aesthetic result is inferior, however, due to the use of
alterations in speech, facial animation, or the oral phase of     tissue with characteristics other than the recipient area, it
swallowing.                                                       requires a higher level of technical expertise and is less re-
At the aesthetic level, patients were asked about their sat-      liable. Medium- and large-sized lower lip defects can be
isfaction or desire to improve the surgical result. Only one      resolved with various pedicled flaps of facial tissue. For
patient requested a reduction of the redundant labial mu-         instance, the inverted Karapandzic flap is easy to perform,
cosa.                                                             but its design entails a risk of microstomia in defects larger
                                                                  than 50% of the lip. This limitation can be resolved by the
Discussion                                                        addition of an inverted Abbe flap 12, although this increases
                                                                  the technical difficulty and involves a second surgery. Few
Reconstruction of facial defects owes its complexity to the       flaps allow reconstruction of the entire lip without caus-
wide variety of anatomical subunits 1, and this is especially     ing a lip microstomia. The Yu flap is one of the most com-
the case for the lip. The vermilion is a mucosa specifically      plete pedicle flaps for lower lip defects. Its compliance with
adapted to external exposure, and the mobility of the entire      the lines of tension of the lower one-third of the face, the
lower lip assembly enables speech, swallowing, oral com-          creation of a neo-vermilion and its wide design provide a
petence, facial mimicry and correct aesthetics, all of which      satisfactory and symmetric esthetic result that is also func-
are key elements for the patient’s psychosocial well-being.       tional, while avoiding the risk of microstomia. Compared
The Colmenero flap is an axial type of flap that uses the         to the Colmenero flap, the Yu flap involves a higher level of
skin, muscle and mucosa adjacent to the lower lip defect,         technical difficulty and a smaller supply of tissue, but bet-
thereby providing a tissue similar to that resected; it is also   ter aesthetic acceptance and equal or greater lip closure 13.
performed as part of the same surgical procedure as tumour        In our experience, the final functional and aesthetic results
resection 10. This similarity of the tissue, the possibility of   of the Colmenero flap were satisfactory in all cases, even
creating a neo-vermilion and the muscular band of the up-         if half of patients required surgical retouching at a second
per lip results in fewer functional repercussions and a good      stage. Retouching can, however, readily be performed with
aesthetic result. All patients achieved complete lip compe-       local anaesthesia in patients with high surgical risk.
tence and there were no limitations during feeding or the         The 8th Edition of the TNM 3 includes the depth of infiltra-
oral phase of swallowing. The need for a bilateral flap for       tion of the lesion as criteria, and hence, the length of the lip
lesions exceeding 60-70% of the lip can be replaced by a          lesion is not proportional to the T classification in all cases.
unilateral flap for patients with loose skin, especially with     In our series of patients, we only treated T1, T2, and T3
older patients.                                                   tumours, although it should also be possible to use this flap
Its straightforward design and the constant location of a         with T4 tumours.
vascular pedicle of sufficient caliber, such as the inferior      One of the supposed limitations of the Colmenero flap is
labial artery, make it a reliable flap. Indeed, no signs of       that it does not match facial tension lines. Despite this, we
necrosis were noted in any of our patients. Furthermore, the      achieved good aesthetic results in our patients. One of the
possibility to perform a single unilateral flap in most cases     drawbacks of this technique is that it is not a flap specifi-
considerably reduces surgical time. Moreover, this flap is        cally designed for lip commissure defects, which, there-
recognised for its versatility, as it allows good mobilisa-       fore, reduces its indications. Another limitation is that half
tion and tailoring to the defect, which can be increased if       of the patients required a touch-up of the surgical suture
designed on an island flap.                                       to increase oral competence or to resolve a dehiscence, al-
Venous drainage occurs in the veins adjacent to the feeding       though all touch-ups performed were minor and could be
artery, and it is highly recommended that the integrity of        completed successfully.
the facial artery is preserved, especially in patients requir-
ing cervical lymph node dissection.
Other reconstructive options have been extensively de-
                                                                  Conclusions
scribed in the literature. Direct closure is the most straight-   The Colmenero flap is a good method for medium- and
forward approach, although it is reserved for defects of less     large-sized lower lip reconstructions due to its reliability,
than one-third of the lower lip 5 due to the risk of oral func-   limited complications and good aesthetic and functional



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results. The ease of performing the procedure and of tailor-                 5
                                                                                  Calhoun KH. Reconstruction of small- and medium-sized defects
                                                                                  of the lower lip. Am J Otolaryngol 1992;13:16-22. https://doi.
ing it to the defect, the large contribution of tissue similar                    org/10.1016/0196-0709(92)90093-9
to that resected, the simple location of the pedicle and the                 6
                                                                                  Abbe R. A new plastic operation for the relief of deformity due to
possibility of creating a neo-vermilion make it a useful and                      double harelip. Plast Reconstr Surg 1968;42:481-483.
suitable technique for lower lip repairs.                                    7
                                                                                  Karapandzic M. Reconstruction of lip defects with lo-
                                                                                  cal arterial flaps. Br J Plast Surg 1974;27:93-97. https://doi.
                                                                                  org/10.1016/0007-1226(74)90068-x
Acknowledgements                                                             8
                                                                                  Yu, J.M. A new method for reconstruction of the lower lip after tumor
                                                                                  resection. Eur J Plast Surg 19899;2:155-159. https://doi.org/10.1007/
We would like to thank Dr. Sancho for his advice and                              BF00214349
teachings.                                                                   9
                                                                                  Fujimori R. “Gate flap” for the total reconstruction of the low-
                                                                                  er lip. Br J Plast Surg 1980;33:340-345. https://doi.org/10.1016/
                                                                                  s0007-1226(80)90079-x
References                                                                   10
                                                                                  Colmenero B. Reconstrucción del labio inferior en cirugía oncológi-
1
    Vanison C, Beckmann N, Smith A. Recent advances in lip recon-                 ca. Tiempos Médicos 1981;182:101-110.
    struction. Curr Opin Otolaryngol Head Neck Surg 2019;27:219-226.         11
                                                                                  Whetzel TP, Mathes SJ. Arterial anatomy of the face: an analysis of
    https://doi.org/10.1097/MOO.0000000000000531                                  vascular territories and perforating cutaneous vessels. Plast Reconstr
                                                                                  Surg 1992;89:591-603.
2
     Cerezo L, Liu FF, Tsang R, et al. Squamous cell carcinoma of the lip:
    analysis of the Princess Margaret Hospital experience. Radiother On-
                                                                             12
                                                                                  Uglesic V, Amin K, Dediol E, et al. Combined Karapandzic-Abbé/Est-
    col 1993;28:142-147. https://doi.org/10.1016/0167-8140(93)90006-t             lander/Stein flap for subtotal and total lower lip reconstruction. J Plast
                                                                                  Reconstr Aesthet Surg 2019;72:484-490. https://doi.org/10.1016/j.
3
    Brierley J, Gospodarowicz MK, Wittekind CH, editors. TNM classi-              bjps.2018.11.005
    fication of malignant tumours. Eighth edition. Oxford, UK, Hoboken,      13
                                                                                  López AC, Ruiz PC, Campo FJ, et al. Reconstruction of lower lip de-
    NJ: John Wiley & Sons Inc.; 2017.                                             fects after tumor excision: an aesthetic and functional evaluation. Oto-
4
    Baker SR. Current management of cancer of the lip. Oncology                   laryngol Head Neck Surg 2000;123:317-323. https://doi.org/10.1067/
    1990;4:107-120.                                                               mhn.2000.104949




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