Introduction

The lips are the most important anatomical and functional part of the lower segment of the face, since they contribute to chewing, speech, facial expressions, etc., so the loss of these structures constitutes an imperative necessity of reconstruction due to the physical and emotional sequels that may have, and the impact on patient quality of life.

Case Report

A 35 year old female patient with no medical history, who presents with psychotic crisis and as a result with a self-inflicted injury with total amputation of the lips, partial amputation of the right breast and nails removal of both hands. Seen at first in primary care by general practitioner who performs amputated lip re-insertion and breast and hands healing; then subsequently refer to the General Hospital of Puebla where is assessed by psychiatrist who diagnose her with schizophrenia and initiate treatment and plastic surgery who decides surgical reconstruction. (Figure 1)

Debridement of de-vitalized tissue (Figure 2) was performed, observing total loss of the upper and lower lip, and it was decided to perform reconstruction of the upper and lower lip in a single time with tongue flap.

Lateral incisions were made on tongue borders to make two flaps, which were then rolled to the upper lip joining the midline, an incision was made at the base of the tongue in front of the frenulum to make the flap for the lower lip, a "Y" advancement flap was performed on the chin and nasogenian folds bilateral flap, which was rotated to the base of the nose and nasal wings for elongation of the upper lip. She remained hospitalized, being fed by gastrostomy tube and with psychiatric treatment (Figure 3). Three weeks later flap release was scheduled, with flap viability and acceptable aesthetic result.

The patient was transferred to a psychiatric hospital. The patient could not be assessed in the long term and since she was discharged by relatives and did not return for further consultation. Tongue flaps were described for use in intraoral reconstruction of a soft palate defect [1], variants of flap design for temporary or definitive coverage of small defects (Conley 1966), correction of lip deformities (Guerrero-Santos) and reconstruction for treatment of electrical burns (Ortiz-Monasterio) and for closure of palatal fistulas [2].

Conclusion

The tongue flap is a technique widely described by Dr. Guerrero Santos and allows total reconstruction of the upper or lower lip, for this specific case, with a very rare and maybe even unique wound type; it was decided to join these two reconstruction techniques in a single surgical time with a good result and decreasing recovery time.

Figure 1: Patient preoperative in which lip graft necrosis is observed

Figure 2: Defect after devitalized tissue resection.

Figure 3: Immediate post-operative result.

1.      Guerrero-Santos J, Vasquez-Pallares R, Vera-Strathmann A, Machain P, Castaneda A (1964) Tongue flap in reconstruction of the lip. Third Int, Congress Plastic Surgeons, Amterdam, Excerpta Medica Foundation.

2.       Siqueira JE, Alvarez GS, Laitano FF, Escobar-Martins PD, Oliveira MP (2012) Lower lip reconstruction strategies. Rev Bras Cir Plást 27: 536-541.