Full-Thickness Skin-to-Mucosa Nasolabial Flap: A Modified Technique for Lip Reconstruction
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Published on: December 5, 2025
Amir Mossaad Zaid1, Mahmoud Soliman Mostafa2, Ismail Abdelgawad Elzanaty3
1Associate professor of surgical oncology, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura city, Egypt.
Introduction:
The nasolabial flap (NLF) is widely used for reconstructing oral and maxillofacial defects, including upper and lower lip defects. It can reconstruct cutaneous, mucosal, and full-thickness defects, including those involving the oral commissure. The flap may be designed as a random, axial, or perforator-based flap, with superior or inferior pedicles, and performed as a pedicled or island flap.
Materials And Methods:
This retrospective study included 11 patients with full-thickness lip defects involving more than half of the lip length following tumor resection. A full-thickness NLF was used for single-stage reconstruction of upper and lower lip defects. Surgical complications, functional recovery, and aesthetic outcomes were evaluated.
Results:
The study included six males and five females, with a mean age of 60 years (range, 36-81). Squamous cell carcinoma was the most common histopathology (6 patients, 54.5%), and the lower lip was the predominant site (7 patients, 63.6%). Six patients underwent cervical lymph node dissection, with nodal metastases in two; four required bony resection. Mean operative time was 202 minutes, flap harvesting time was 73 minutes, and hospital stay was six days. No total flap loss occurred; partial or superficial necrosis developed in two patients (18.2%), while three (27.3%) experienced self-resolving venous congestion. Normal speech was observed in nine patients (81.8%), full oral competence in seven (63.6%), and resumption of a normal diet within 4-6 weeks in nine (81.8%). Aesthetic outcomes were excellent or good in nine patients (81.8%). Recurrence occurred in two patients (18.2%), one local and one nodal.
Discussion:
This preliminary series demonstrates the feasibility of using a composite skin-to-mucosa NLF for single-stage reconstruction of extensive full-thickness lip defects. Despite minor flap complications, functional and aesthetic outcomes were encouraging. The technique may represent an alternative to free-flap reconstruction, particularly where microsurgical resources are limited. However, the small sample, retrospective design, and absence of a control group limit interpretation. Larger comparative studies are needed to confirm its safety and effectiveness.