Fan Flap

Description

The fan flap, originally described by Gillies in 1954, derived its name from its resemblance to the rotational opening of a handheld fan. The flap is full-thickness including mucosa and is based on the opposing lip's labial artery. In designing the flap, the opposing lip's white line is marked at a point away from the lateral aspect of the defect along the vermilion equal in length to the width of the defect. This mark represents the area on the opposing lip that will become the new commissure after flap inset. Extending out from this mark, along a radiant RSTL, a full-thickness incision is made approximately 1.5 cm in length. The incision is then turned acutely at an angle of approximately 60 degrees to the outer part of the nasolabial fold. The incision then follows the fold and turns acutely toward the defect to match the height and width of the flap to the height and width of the defect. To facilitate flap transfer, an opposing 60 degrees angled incision from the nasolabial fold is made into the cheek, creating a Z-plasty at the base of the flap.

Indications

The fan flap is primarily indicated for full-thickness defects of the central upper or lower lips. The use of bilateral symmetrical flaps results in the most cosmetic reconstruction. Defects involving between one-third and one-half of the lower lip may be repaired with a unilateral fan flap, but an Estlander flap may be more appropriate.

Advantages

The fan flap provides actual lip tissue for replacement of the lost segment of lip. Disadvantages

The use of a classic fan flap always results in some degree of microstomia. The mod-iolus is malpositioned and a second stage is required for commissuroplasty. The sensory and motor nerves to the transposed segment of orbicularis oris muscle are divided, resulting in a nonsensate and adynamic repair. The Karapandzic flap attempts to improve on this type of flap design by preserving the sensorimotor components to the transposed lip segment. However, some sensory and motor reinnervation may occur with the fan flap as seen with the Abbe; and Estlander flaps, taking up to 2 years for maximal return.

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