Lower Lip Reconstruction after Wide Excision of a Malignancy with Barrel-Shaped Excision or the Webster Modification of the Bernard Operation

Background Because there are numerous methods for reconstruction of the lower lip,it is not easy to choose the optimal method. In choosing the surgical method for lowerlip reconstruction, we obtained acceptable outcomes based on our treatment strategy,which included either a barrel-shaped excision or the Webster modification of the Bernardoperation. We report on the surgical outcomes based on our treatment strategy.Methods This study included 26 patients who underwent lower lip reconstructive surgeryfrom September 1996 to September 2010. The operation was done using either a barrelshapedexcision or the Webster modification, considering the location of the defect, the size ofthe defect, and the amount of residual tissue on the lateral side of the vermilion after excision.Results In our series, 3 patients underwent a single barrel-shaped excision, and nine patientsunderwent a double barrel-shaped excision. In addition, the unilateral Webster modificationwas performed on in 6 patients, and there were eight cases of bilateral Webster modification.All of the patients except one were satisfied with the postoperative shape of the lip. In onecase both recurrence and dehiscence occurred. One patient had a good postoperative lip shape,but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore,there were two patients who complained of drooling, and 4 with paresthesia.Conclusions A soft tissue defect resulting from wide excision of a lower lip malignancy canbe successfully reconstructed using only one of two surgical methods: the barrel-shapedexcision or the Webster modification of the Bernard operation.