Challenges and results of lip defect reconstruction in Sudan: a retrospective cohort study in a low-resource setting

The lips play a crucial role in both the function and aesthetics of the face. Social interactions, speech, swallowing, and oral competence depend on a well-functioning dynamic structure. There are various options available for reconstructing lip defects. This study aims to assess, for the first time, the causes, reconstructive methods, immediate complications, and outcomes of lip defect care in Sudanese patients. This retrospective cohort study was conducted at multiple centers from January 2020 to August 2023. All patients with acquired lip defects who underwent reconstruction were included in the study. A total of 60 patients, predominantly males (53%), with an average age of 43 years, underwent lip reconstruction and were included in this study. Tumour excision accounted for 58% of defects, traumatic defects 32%, infection-related defects 7%, and burns 3%. The lower lip was affected in 55% of patients, with 66.7% of defects being full-thickness. 58% of patients had defects affecting less than one-third of the lip, while 26.7% had defects affecting more than two-thirds of the lip. Primary closure, mucosal advancement, and local flaps were the primary methods used for smaller lip defects, while regional flaps like the deltopectoral and pectoralis major flaps were used for extensive defects. Early complications were observed in 21.7% of participants and were significantly associated with larger lip defect sizes (Cramer’s V = 0.49, 95% CI: 0.32–0.73, P < 0.001). Functional outcomes were generally good for smaller defects, with 80% of patients maintaining everyday speech and 75% retaining normal speech. Patient satisfaction was high (68%), especially among those with small defects reconstructed using primary closure or local flaps. In a resource-limited Sudanese setting, early functional outcomes, patient satisfaction, and complication rates align with regional and global reports. However, larger defects pose challenges and lead to less favourable outcomes, particularly in the absence of microsurgical reconstruction.