Complications Following Karapandzic Flap Reconstruction of the Lip: A Retrospective Cohort Study

<i>Background and Objectives</i>: Squamous cell carcinoma (SCC) of the lip is a common malignancy of the oral and maxillofacial region. Medium-to-large post-excisional defects often require reconstructive techniques that preserve oral competence, function, and facial aesthetics. Despite its broad clinical use, the Karapandzic flap lacks comprehensive evidence describing its postoperative outcomes and associated complications. <i>Materials and Methods:</i> This retrospective cohort study evaluated all consecutive patients who underwent lip SCC excision followed by Karapandzic flap reconstruction at a tertiary oncologic center in Greece from 2000 to 2024. Demographic, clinical, pathological, and postoperative data were collected, and complications were categorized as early (wound dehiscence, surgical site infection, hematoma) or late (microstomia, excessive scarring). Statistical analyses included comparative tests and Firth's logistic regression to explore potential predictors of morbidity. <i>Results:</i> A total of 102 patients met the inclusion criteria. Most were male (82.4%) with a median age of 68.8 years, and 94.1% had lower-lip tumors. Early complications occurred in 9.8% of patients and late complications in 17.7%, with microstomia being the most frequent late event (15.7%). Age was the only variable showing a borderline significant association with overall complications. No demographic, clinical, or pathological factor, including lesion morphology, cytological diagnosis, tumor location, or presence of metastasis, demonstrated a statistically significant association with early or late complications. <i>Conclusions:</i> Karapandzic flap reconstruction represents a reliable single-stage option for lip SCC defects, demonstrating relatively low complication frequencies and generally favorable functional outcomes. Further comparative studies are warranted to evaluate its performance relative to alternative reconstructive techniques.