Retrospective Cohort Study Rethinking Lip Reconstruction: Versatility of the Depressor Anguli Oris Myocutaneous Flap for Large Full-Thickness Defects

Background Large full-thickness lip defects present a reconstructive challenge. Objective Describe the impact of the depressor anguli oris myocutaneous (DAOM) flap as an axial pattern transposition flap for reconstruction of large, full-thickness lip defects, on clinical outcomes and institutional cost. Methods Multi-center retrospective cohort study of adults with large full-thickness lip defects who underwent DAOM flap reconstruction from 2011 to 2018. DAOM flap anatomy and surgical technique are reviewed. The primary outcome of flap viability as well as additional clinical outcomes of postoperative complications and functional results are documented with follow-up ranging up to eleven years. Median length of stay and average institutional cost of care are reported. Results 12 patients underwent DAOM flap reconstruction for large full-thickness lip defects. There was 100% flap survival with no episodes of reoperation or readmission. All patients reported maintenance of distinct oral commissures, wide oral opening and full gingivolabial sulcus, excellent oral competence, and intelligible speech. Mean case length was 144 +/- 11.5 minutes with mean length of stay of 1.6 +/- 0.5 days and estimated mean institutional cost of $3,766.67 +/- $1,167.06. Conclusions The DAOM flap presents an excellent reconstructive option for large full-thickness lip defects with strong functional results with limited donor site morbidity and institutional cost of care. Large full-thickness lip defects present a reconstructive challenge. Describe the impact of the depressor anguli oris myocutaneous (DAOM) flap as an axial pattern transposition flap for reconstruction of large, full-thickness lip defects, on clinical outcomes and institutional cost. Multi-center retrospective cohort study of adults with large full-thickness lip defects who underwent DAOM flap reconstruction from 2011 to 2018. DAOM flap anatomy and surgical technique are reviewed. The primary outcome of flap viability as well as additional clinical outcomes of postoperative complications and functional results are documented with follow-up ranging up to eleven years. Median length of stay and average institutional cost of care are reported. 12 patients underwent DAOM flap reconstruction for large full-thickness lip defects. There was 100% flap survival with no episodes of reoperation or readmission. All patients reported maintenance of distinct oral commissures, wide oral opening and full gingivolabial sulcus, excellent oral competence, and intelligible speech. Mean case length was 144 +/- 11.5 minutes with mean length of stay of 1.6 +/- 0.5 days and estimated mean institutional cost of $3,766.67 +/- $1,167.06. The DAOM flap presents an excellent reconstructive option for large full-thickness lip defects with strong functional results with limited donor site morbidity and institutional cost of care.