Flap modalities for reconstruction following excision of vascular malformation on lower lip: a review with a case report

Background:

Capillary malformations (CMs) and Lymphatic malformation (LMs) are vascular malformations that share a common tendency to cause soft and hard tissue hyperthropy, expressed in the three dimensions of the space. Although middle third of the face is the most commonly involved area, with a predominance of upper lip, the lower lip sometimes involved in some cases too. Vascular malformations of the lip often require reconstructive surgery with meticulous attention to both aesthetic and functional purposes. The lip reconstructive rule of thirds suggests that lower lip defects involving 1/3-2/3 total lip width require closure with lip switch or local advancement flap techniques (Karapandzic, Abbe, or Estlander).

Case Description:

36 years old woman with bluish tumor lesion on lower lip since childhood, came to our clinic with history of  small lesion enlarging slowly, bluish in color, elastic in palpation, no bruit in auscultation. She had underwent surgery to reduce the size of lesion twice while childhood and in adult. Then she felt the lesion became bigger and fulfilling the right edge extended to two third of the lower lip. She felt a little bit itchy, and a difficulty in eating. The surgeon performed a wide excision continued using lip reconstruction Karapandzic flap. The final result of the reconstruction is satisfactory for the patient, and no recurrence nor complication existed.

Discussion:

Vascular malformation which underwent correcting surgery should consider certain guidelines regarding anatomic consideration and therefore appropriate reconstruction according guideline methods, such as close primarily, Karapandzic, Estlander, Abbe, Bernard-Burrow, distant free flap, will provide good anatomical and physiological result in attected lip. The surgeon choose to perform Karapandzic method for this patient because Karapandzic is probably the better choice because it’s better at maintaining oral competence. Larger lip defects over 50% of the lip can be reconstructed by Karapandzic flap. 

Conclusion:

Karapandzic flaps is probably proper alternative due to reducing the larger lower lip defect (more than two-thirds of lip) which give a satisfying result of this patient.

Papulonecrotic tuberculid: a case report

Introduction: Papulonecrotic tuberculid (PNT) is a chronic, recurrent, and symmetric eruption of necrotising skin papules in crops involving the arms and legs, and healing with scar formation. PNT is an uncommon disorder, occurring in less than 5 % of cases of active TB. The pathophysiology of this disease has remained controversial.

Case: A 31 years old Balinese woman, visited Outpatient Clinic Department of Dermatology and Venereology Sanglah Hospital Denpasar in 8^th September 2003, she has complained of recurrent ulcer for 14 years ago. The clinical feature showed papules, multiple ulcer, and scars, symmetrically on her arms, legs and trunk. Mantoux skin test was strongly positive with 13 mm induration. Lymphohystiocytic vasculitis was found on cell pathology examination, there is no evidence of microbial growth in culture, Ziehl-Neelsen staining and PCR was negative. She was given anti-tuberculosis with a rapid improvement after therapy for 6 months with no significant adverse event.

Conclusion: Treatment for six months using anti-tuberculosis drugs provides satisfactory results with clinical improvement in patients with PNT.