PMC7305348_01
Case #1. A) Pre-operative appearance. Note the tight oral commissures, B) flap transposition. Note that the undersurface of the flap pedicle is covered with a skin graft, C) The cosmetic result at one year is satisfactory, D) The functional outcome is excellent with adequate release of the oral commissures.
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There was severe upper lip burn contracture and tight oral commissures (Fig. 1a). Removal of the expander and flap transposition was done in the second stage (Fig. 1b). At final follow-up one year later, the cosmetic and functional outcomes were satisfactory and the patient was satisfied with the results (Fig. 1c, d).
PMC7305348_02
Case #2. A) Pre-operative appearance. Note the concurrent tight oral commissures and the severe bilateral nostril stenosis. Also note that the skin deficiency in the upper lip is more severe in the central part of the lip, B) Appearance after the first stage during which 3 procedures were done: commissuroplasty, W-plasty/stenting of the nostrils, and the insertion of the tissue expander in scalp. Note that the expander crosses the mid line in the scalp, C) Appearance at 9 months. The moustache was intentionally shaved to show that the reconstruction was done as one aesthetic unit. Some of the native skin from the lateral aspects of the lip was excised to achieve this goal (compare to Fig. 2a), D) Appearance with scalp hair growth within the flap. The patient is taught to do regular trimming of the hair.
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There was also bilateral severe nostril stenosis and bilateral tightness of the oral commissures (Fig. 2a). The first stage included bilateral commissuroplasty, bilateral nostril stenosis correction, and the insertion of the tissue expander in the scalp (Fig. 2b). At final follow-up 9 months later, the cosmetic and functional outcomes were satisfactory and the patient was satisfied with the result (Fig. 2c, d).