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Squamous cell carcinoma of the lower lip reconstructed using "staircase" flap technique.

The most common cancer of the lower lip is squamous cell carcinoma (SCC). Micrographically controlled surgery (Mohs surgery) is the golden standard of therapy in localized SCC. Since the majority of lip cancer patients is >60 years of life, planning of surgery and reconstruction has to consider the age and co-morbidities. The staircase or step technique is a robust method to achieve a good functional reconstruction in a one-step procedure. The bilateral staircase technique of Johanson et al. can be used to close medial defects of one third to up to two-thirds of the lower lip. Basically it represents a skin-muscle-mucosal flap for lower lip reconstruction. The lip cancer is removed in a rectangular fashion with appropriate free margins. The cut goes through all layers including orbicularis muscle and mucosa. The staircase technique provides a good sensory and motor innervation with satisfying functional outcome. Meticulous haemostasis is necessary before any wound closure. For full-thickness defects a three-layer suture is performed with polybraided non-absorbable sutures for intraoral mucosa and vermillion and non-absorbale monofilamentous sutures for the cutaneous repair. The orbicularis muscle and submucosa are sutured by absorbable material like vicryl.