Subcutaneous pedicle subunit flap for upper lip reconstruction

Facial basal cell carcinomas often develop on the congenital facial cleft and require surgical removal. The upper lip is in a prominent facial aesthetic position, therefore requiring surgeons to be careful when reconstructing skin defects in this area. Generally, such defects are reconstructed with a skin flap from the cheek or an advancement skin flap that makes good use of the nasolabial fold line. However, depending on the reconstruction method, the scar may be noticeable or contracture may occur. Herein, we report the case of an 84-year-old patient with basal cell carcinoma who underwent successful upper lip reconstruction with a local skin flap. A subcutaneous pedicle subunit flap was used during the reconstructive surgery, resulting in very mild traction, symmetrical nasolabial folds, and no problems opening or closing the mouth 6 months postoperatively. The upper lip is formed as a single unit with the central portion as the boundary, but by dividing this unit into subunits along a line perpendicular to the orbicularis oris muscle and moving each of these subunits as a skin flap, we minimized postoperative scarring by aligning most of the sutures with the relaxed skin tension line. This skin flap technique is useful in the reconstruction of upper lip skin defects.