Upper lip reconstruction with the alar crescent flap: A new approach

The alar crescent advancement flap technique has been widely used for repair of large central defects of the upper lip and base of the nose because of its 1-stage procedural simplicity and good results. Several more complicated and multiple staged procedures that respect either structure or function, often compromising one to achieve the other, have become popular and have recently taken its place. However, these procedures are more complex and in many cases require a staged approach. In this study, we present a series of 33 patients who underwent reconstruction of large upper lip defects utilizing alar crescent flaps between 1992 and 2002.

A series of 20 patients underwent reconstruction of large upper lip defects using alar crescent flaps between 1992 and 2002. Malignant etiologies were responsible for the defect in all patients. Reconstruction was performed as a 1-staged procedure in 19 cases. In 1 patient with a total upper lip defect, bilateral alar crescent flaps were used in conjunction with a cross lip flap that was later divided in a second stage procedure.

All patients tolerated the procedure well with no major complications. Minor complications not requiring surgical intervention occurred in 5 patients. During the 12- to 60-month follow-up, all patients were found to be satisfied with the functional result. However, 7 patients underwent minor surgical procedures for esthetic improvement. There was no recurrence of disease in the 20 patients who underwent resection of malignancy.

In these 20 cases, we have shown the utility of the alar crescent flap for varying length partial and full-thickness reconstruction of upper lip defects. This simple and straightforward technique provided good functional and esthetic results. The disadvantage of this procedure is the loss of philtral anatomic detail. Its primary advantage is that it is a single-stage procedure with a relatively low morbidity and patient inconvenience. As a single-stage technique it satisfies concerns over cost containment over more complex and staged procedures while still providing a good functional and cosmetic result. Furthermore, for those same reasons, this procedure is a good first choice in the elderly.