Results of a modified staircase technique for reconstruction of the lower lip.

Our experience with a modified staircase technique for closure of lower lip defects is reported. The procedure is based on the original technique of Johanson et al. (1974). However, the integrity of the orbicularis oris muscle is respected when advancing lower lip flaps. Twenty patients with squamous cell carcinoma of the lower lip were treated using this modified reconstruction technique. The size of the defects ranged from 30-60% of lower lip width. No recurrences were observed during a 3-year to 5-year follow-up. All patients showed symmetrical lip movement, an adequate buccal sulcus and intact labial commissures. No symptomatic microstomia was seen and the aesthetic results were excellent. The surgical technique is explained in detail. Four types of flap are presented according to the size and location of lip defects. Lower lip defects up to 60% of the lip width can be closed easily, with good aesthetic results. The technique is also applicable to upper lip reconstruction.