Use of Estlander flap in second surgery for lip prepair

Cancer resection is the most frequent cause of skin loss of the lip. Many surgical methods of lower lip reconstruction have been described in the literature. The choice of option depends on the amount of tissue missing. We present a case of a 69-year-old male with cancer of the lower lip. The patient underwent lesion excision and repair of the wide defect by an Estlander flap. As second procedure this reconstruction results in a proportionate size reduction in both lips and loss of the normal thinning of the vermilion. Anatomical and functional bases of this flap are reported and discussed. The Estlander flap initially described in 1872, can be used efficaciously for the reconstruction of both the upper and the lower lip, with particular advantage when less than one-half of the lower lip has to be reconstructed, and is the best choice for defects that include the commissure. The main advantages of this flap are the good functional recovery, the single-stage procedure and the acceptable aesthetic result. Our patient was smoker, diabetic and had peripheral vascular disease. Diabetes mellitus is associated with vascular problems, which frequently result in surgical complications. Comorbidities may complicate postoperative recovery, so the decision-making process must involve the assessment of patient concomitant disease, surgical tolerance, aesthetic expectations and wound factors as well.