AB200. SOH24AB_248. The utility of Estlander flap in reconstruction of commissure of the lip

Background: The Estlander flap is a technique utilising a lip switch flap to reconstruct large defects with a low risk of necrosis due to the abundant blood supply of the lip. This poses an alternative to the Abbe flap and is particularly effective for commissure defects. We present 2 cases demonstrating the success of the Estlander flap in the reconstruction of significant commissure defects.

Methods: This technique involves mobilising full-thickness lip tissue from the uninvolved lip and rotating it 180 degrees superiorly or inferiorly to the site of the defect. The donor site is closed primarily and the recipient site closed by layers. The first case outlines the reconstruction of a 35 mm × 35 mm defect of the right commissure on a 65-year-old female following the excision of a mucoepidermoid carcinoma. The second case involves a 75-year-old male with a 30 mm × 20 mm defect following excision of an infiltrative basal cell carcinoma of the right lower lip.

Results: The Estlander flap achieves the functional goals of preserving the lip commissure, maintaining lip competence, mouth opening and lip sensation, along with an acceptable aesthetic outcome. The pedicled flap is well-vascularised by the contralateral superior labial artery, which is favourable for healing.

Conclusions: Every attempt should be made to preserve functional and aesthetic goals in the reconstruction of commissure defects. The Estlander flap has proven to be a robust method to restore such defects. Our case series outlines satisfactory results of lip reconstruction with minimum morbidity in the hands of an experienced clinician.

Keywords: Commissure; Estlander; flap; mucoepidermoid; reconstruction