Expert Surgical Guide: How to do a Karapandzic Flap?

September 21, 2025 •

4 min read

Functional and aesthetic lip reconstruction is a complex surgical challenge, with techniques like the Karapandzic flap offering excellent outcomes for specific defects. Learning how to do a Karapandzic flap involves mastering its unique approach, which preserves vital neurovascular structures to maintain sensation and function.

Quick Summary

The Karapandzic flap is a lip reconstruction technique that utilizes adjacent musculocutaneous tissue to repair moderate to large lip defects, notably preserving the orbicularis oris muscle and its neurovascular supply to maintain function and sensation.

Key Points

Preservation of Function: The Karapandzic flap's core advantage is its preservation of the orbicularis oris muscle and critical neurovascular structures, maintaining sensation and oral competence.
Step-by-Step Precision: The procedure involves careful incision marking, meticulous blunt dissection to protect nerves and vessels, flap mobilization, and multi-layered closure for optimal results.
Risk of Microstomia: A notable potential disadvantage is the narrowing of the mouth opening, which is more likely with larger defects but can sometimes be corrected later.
Based on Labial Arteries: The flap relies on the robust vascularity of the labial arteries for its blood supply, ensuring high flap viability.
Single-Stage Procedure: In contrast to multi-stage techniques like the Abbe flap, the Karapandzic flap can often be completed in a single surgical session.
Ideal for Central Defects: It is an excellent choice for reconstructing medium to large central defects of both the upper and lower lip.

Understanding the Karapandzic Flap

First described in 1974, the Karapandzic flap is a pedicled rotation-advancement flap used for reconstructing medium to large lip defects, including those that involve the oral commissures. Unlike earlier techniques that transected the perioral muscles and nerves, the Karapandzic method is distinctive for its meticulous intramuscular dissection. This crucial step allows the surgeon to preserve the function of the orbicularis oris muscle and the sensory and motor nerves, ensuring the patient retains vital functions like oral competence, articulation, and emotional expression. The flap is based on the rich blood supply from the labial arteries, providing a reliable source of vascularization.

Indications and Patient Selection

Proper patient selection is paramount for a successful Karapandzic flap reconstruction. The procedure is best suited for central lip defects measuring less than two-thirds of the upper or lower lip, though extended techniques can address even larger defects. It is particularly effective for defects where the goal is to maintain oral competence and sensation. However, a potential drawback is the risk of microstomia, or narrowing of the mouth opening, which may necessitate careful patient counseling. Other key considerations include:

Defect Size: Ideal for medium to large defects, often following cancer resection.
Adjacent Tissue Availability: Sufficient cheek tissue is necessary for mobilization and rotation of the flap.
Patient Factors: The patient's overall health, presence of previous scarring or radiation, and functional requirements (e.g., wearing dentures) must be considered.

The Step-by-Step Surgical Technique

Performing a Karapandzic flap is a precise surgical procedure typically performed under general anesthesia. It is crucial to mark the incisions carefully preoperatively to ensure optimal cosmetic and functional outcomes.

Marking Incisions: The surgeon marks semicircular incisions extending from the defect towards the oral commissures and along the melolabial folds. For lower lip reconstruction, this follows the labiomandibular creases. These markings are critical for planning the flap's rotation.
Incision and Blunt Dissection: The initial incision is made through the skin and subcutaneous tissue. Blunt dissection is then meticulously carried out to separate the orbicularis oris muscle from the surrounding structures while preserving the labial arteries and buccal nerve branches. This step is the hallmark of the Karapandzic technique.
Flap Mobilization: The surgeon separates the orbicularis oris muscle longitudinally, parallel to its fibers, mobilizing the flap from the adjacent musculature. This allows the myocutaneous flaps to be advanced medially towards the defect.
Flap Rotation and Advancement: The mobilized flaps, still connected by their neurovascular pedicles, are rotated medially to close the lip defect. The integrity of the oral sphincter is re-established.
Multi-Layered Closure: The closure is performed in three layers: first, approximating the oral mucosa; second, re-joining the orbicularis oris muscle; and finally, closing the skin. Precise alignment of the vermilion border is essential for a good aesthetic result.
Suturing: A stay suture is placed for the vermilion border, and the rest of the incision is closed meticulously with absorbable sutures for the deeper layers and non-absorbable ones for the skin.

Advantages and Disadvantages of the Karapandzic Flap

Advantages:

Preservation of Function: Retains oral competence, speech, and sensation by preserving the orbicularis oris muscle and its neurovascular supply.
Single-Stage Procedure: The reconstruction can often be completed in a single operation.
Excellent Tissue Match: Utilizes local lip and cheek tissue, providing an ideal color, texture, and contour match.
Versatility: Suitable for reconstructing medium to large defects, particularly those involving the oral commissure.

Disadvantages:

Risk of Microstomia: Can result in narrowing of the mouth opening, especially with larger defects.
Commissure Distortion: May cause rounding or distortion of the corners of the mouth.
Aesthetic Compromise: For very large defects, the result may not perfectly match the preoperative appearance.

Comparison with Other Lip Flap Techniques


Feature	Karapandzic Flap	Abbe Flap	Gillies Fan Flap	Bernard-Burow Flap
Tissue Source	Adjacent myocutaneous flaps	Cross-lip flap	Adjacent cheek tissue	Adjacent cheek tissue
Sensation	Preserved	Reduced (pedicle transection)	Lost (muscle transection)	Lost (earlier versions)
Motor Function	Preserved	Reduced (denervation)	Reduced (muscle transection)	Lost (earlier versions)
Complexity	Moderate	Higher (requires two stages)	Moderate	Higher (more incisions)
Main Drawback	Microstomia	Two-stage procedure	Denervation, sensation loss	Denervation, sensation loss

Post-Operative Care and Potential Complications

After the procedure, patients are monitored carefully. Oral intake is managed with a clear liquid diet, advanced as tolerated, and prophylactic antiemetics are often administered to prevent stress on the suture lines. Common post-operative issues include temporary swelling, bruising, and discomfort. Longer-term complications are generally low but can include:

Persistent Microstomia: Though it often improves over time, significant narrowing may require secondary correction.
Lip Asymmetry: Variations in healing can lead to mild asymmetry.
Altered Sensation: While sensation is typically preserved, some patients may experience temporary changes.
Wound Dehiscence or Infection: These risks are managed with meticulous surgical technique and post-operative care.

For additional detailed information on the Karapandzic flap, including surgical approaches and case studies, see this authoritative resource: Lower Lip Reconstruction Using the Karapandzic Flap for a Large Basal Cell Carcinoma in the Elderly.

Conclusion

The Karapandzic flap represents a sophisticated and highly effective option for lip reconstruction, particularly for medium-to-large defects that require preservation of function. By prioritizing the meticulous dissection and preservation of the orbicularis oris muscle and its neurovascular supply, surgeons can achieve excellent aesthetic and functional outcomes. While the risk of microstomia exists, proper patient selection and careful technique can mitigate this concern, making it a valuable tool for restoring the complex anatomy and function of the oral region.

Frequently Asked Questions

The main benefit is the preservation of sensation and motor function by carefully dissecting and sparing the neurovascular bundles, including the orbicularis oris muscle and labial arteries.

Microstomia is the narrowing of the mouth opening. It is a known complication, especially for larger defects, but its severity varies and it can often improve over time.

The standard Karapandzic flap is typically used for central defects measuring less than two-thirds of the upper or lower lip, though extended versions can be used for more extensive defects.

Initial healing occurs over several weeks, but final aesthetic and functional results, including any correction of microstomia, may take several months to a year.

Yes, a primary goal of the procedure is to preserve muscle function. By maintaining the integrity of the orbicularis oris muscle, the patient can retain the ability to purse their lips, smile, and convey emotional expression.

The Karapandzic is a single-stage rotational flap that preserves sensation, while the Abbe flap is a cross-lip flap requiring two stages, and can result in denervation.

The flap's blood supply is based on the superior and inferior labial arteries. Careful dissection is performed to preserve these axial vessels, ensuring robust vascularity throughout the procedure.