[Classification of upper lip larger defect and the corresponding surgical plan]

Objective: To classify the extensive defects after upper lip cancer surgery and explore the efficacy of nasolabial flap with Abbe flap combined or vermilion elastic flap in extensive defects after upper lip cancer ablation. Methods: Twenty-seven patients with upper lip cancer who underwent surgical resection in the Department of Oral and Maxillofacial, The Second Xiangya Hospital, Central South University from January 2010 to December 2021 were recruited, including 13 males and 14 females aged from 19 to 78 years old. The defects of upper lip were more than 50%, and local flaps (Abbe flap, nasolabial flap or vermilion elastic flap) were used to reconstruct the defects of upper lip cancer. According to the extent of defects and the application type of flaps, the defects were classified into 3 sub-types: ①Type Ⅰ defect: median upper lip defect, with more than 50% defect of vermilion and nearly complete defect of upper lip skin, which can be repaired by Abbe flap combined with double nasolabial flap.②Type Ⅱ defect: median upper lip defect, with more than 50% defect of vermilion and upper lip skin defect, repaired by Abbe flap alone. ③Type Ⅲ defect: lateral upper lip defect, with more than 50% defect of vermilion and upper lip skin defect. The nasolabial flap was used to reconstruct the skin defect, and the vermilion elastic flap was used to repair the labial redness defect. A four-point scale was used to evaluate the function and aesthetic outcome of the lips 3 months after surgery, and postoperative complications were recorded. Results: Among the included patients with lip cancer, there were 2 cases of type Ⅰ, 9 cases of type Ⅱ, and 16 cases of type Ⅲ. All Abbe flap and nasolabial flap survived, with tip necrosis occurring in 2 Abbe flaps and have been resected. The average functional score was 2.89±0.80, and the average cosmetic score was 3.04±0.76. Conclusions: The reconstructive method based on Abbe flap and nasolabial flap provides a novel surgical technique for the reconstruction of extensive defects after upper lip cancer surgery.