Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada)


  • Alberto Goldman Clinica Goldman - Plastic Surgery, Porto Alegre/RS
  • Uwe Wollina Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen
  • Katlein França Department of Dermatology and Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL
  • Torello Lotti University G. Marconi of Rome - Dermatology and Venereology, Rome
  • Georgi Tchernev Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia; Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia



Non-melanoma skin cancer, Squamous cell carcinoma, Lower lips, Flaps, Defect closure


Squamous cell carcinoma is the most common malignancy of the lower lip. Environmental factors such as ultraviolet light exposure, arsenic and smoking are contributing factors to the increasing incidence. Mohs surgery is the treatment of choice ensuring the lowest recurrence rates. The closure of the surgical defects, however, can be a challenge. Multiple and versatile methods of reconstructing vermilion defects have been described. Among these options, Goldstein developed the adjacent ipsilateral vermilion flap based on an arterialized myocutaneous flap. The original technique was modified by Sawada based on bilateral adjacent vermilion advancement flap for closure of central vermilion defects. We report the use of bilateral flaps - Sawada’s technique (instead of unilateral as suggested by Goldstein) in medium (2 cm of extension) to large defects (> 2 cm) to achieve an effective and functional reconstruction of vermillion defects after Mohs surgery for lip cancer.


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Braz A, Humphrey S, Weinkle S, Yee GJ, Remington BK, Lorenc ZP, Yoelin S, Waldorf HA, Azizzadeh B, Butterwick KJ, de Maio M, Sadick N, Trevidic P, Criollo-Lamilla G, Garcia P. Lower face: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015; 136(5 Suppl):235S-257S.


Schmitt J, Haufe E, Trautmann F, Schulze HJ, Elsner P, Drexler H, Bauer A, Letzel S, John SM, Fartasch M, Brüning T, Seidler A, Dugas-Breit S, Gina M, Weistenhöfer W, Bachmann K, Bruhn I, Lang BM, Bonness S, Allam JP, Grobe W, Stange T, Westerhausen S, Knuschke P, Wittlich M, Diepgen TL; FB 181 Study Group, Bieber T, Brans R, Brecht B, Grabbe S, Küster D, Ruppert L, Stephan V, Thielitz A, Zimmermann E. Is UV-exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population-based case-control study FB-181. Br J Dermatol. 2017; 2017.

Moan J, Grigalavicius M, Baturaite Z, Dahlback A, Juzeniene A. The relationship between UV exposure and incidence of skin cancer. Photodermatol Photoimmunol Photomed. 2015; 31(1):26-35. PMid:25213656

Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol. 2014; 810:120-40.

Bota JP, Lyons AB, Carroll BT. Squamous cell carcinoma of the lip - a review of squamous cell carcinogenesis of the mucosal and cutaneous junction. Dermatol Surg. 2017; 43(4):494-506. PMid:28157733

Pugliano-Mauro M, Goldman G. Mohs surgery is effective for high-risk cutaneous squamous cell carcinoma. Dermatol Surg. 2010;36(10):1544-53. PMid:21053415

Larrabee YC, Moyer JS. Reconstruction of Mohs defects of the lips and chin. Facial Plast Surg Clin North Am. 2017; 25(3):427-442. PMid:28676167

Goldstein MH: A tissue-expanding vermillion myocutaneous flap for lip repair. Plast Reconstr Surg. 1984; 73(5):768-770.

Sawada Y Ara M, Nomura K. Bilateral vermilion flap – a modification of Goldstein's technique. Int J Oral Maxillofac Surg. 1988; 17(4):257-259.

Neligan PC. Strategies in lip reconstruction. Clin Plast Surg. 2009; 36(3):477-485. PMid:19505615

McCarn KE, Park SS. Lip reconstruction. Facial Plast Surg Clin North Am. 2005; 13(2):301-14. PMid:15817408

Wollina U. Reconstructive surgery in advanced perioral non-melanoma skin cancer. Results in elderly patients. J Dermatol Case Rep. 2014; 8(4):103-107. PMid:25621090 PMCid:PMC4299704

Hahn HJ, Kim HJ, Choi JY, Lee SY, Lee YB, Kim JW, Yu DS. Transoral cross-lip (Abbé-Estlander) flap as a viable and effective reconstructive option in middle lower lip defect reconstruction. Ann Dermatol. 2017; 29(2):210-214. PMid:28392650 PMCid:PMC5383748

Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974; 27(1):93-97.

Bernard C. Cancer de la levre inferieure: restauratio a l'aide de lembeaux quadrilataires-lateraux querison. Scalpel.1852; 5:162-164.

Webster RC, Coffey RJ, Kelleher RE. Total and partial reconstruction of the lower lip with innervated musclebearing flaps. Plast Reconstr Surg Transplant Bull. 1960; 25:360-371. PMid:13843351

Wollina U. Reconstruction of medial lower lip defects after tumour surgery: modified staircase technique. J Cutan Aesthet Surg. 2013; 6(4):214-6. PMid:24470719 PMCid:PMC3884887



How to Cite

Goldman A, Wollina U, França K, Lotti T, Tchernev G. Lip Repair after Mohs Surgery for Squamous Cell Carcinoma by Bilateral Tissue Expanding Vermillion Myocutaneous Flap (Goldstein Technique Modified by Sawada). Open Access Maced J Med Sci [Internet]. 2018 Jan. 10 [cited 2021 Apr. 11];6(1):93-5. Available from:

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