Medial Upper Lip Vermillion Reconstruction with a Labial Artery-based Cross-lip Vermillion Flap

Abstract

Summary: A defect of the central upper lip vermillion generally requires “like for like” reconstruction because this part of the upper lip can attract attention and has a unique structure and color. In this article, we report use of a labial artery-based horizontal long cross-lip flap for central upper lip vermillion reconstruction. In the first stage of surgery, a horizontal long vermillion flap from the lower lip starting at the left commissure with a vascular pedicle containing an inferior labial artery was raised and transposed to the upper vermillion defect. In the second stage, 12 days later, the pedicle was divided to complete the reconstruction. There were no postoperative complications in articulation or eating, and the patient was satisfied with the esthetic outcome. This surgical technique reduces microstomia and inconvenience in eating and speaking compared with a common horizontal cross-lip flap and provides better color- and texture-matched tissue compared to reconstruction using a tongue flap or mucosal flap. The technique is simple, requires a relatively short surgical time, has minimum donor-site morbidity and permits good esthetic and functional reconstruction of the central upper lip vermillion for a relatively small defect.

A novel technique of reconstruction of vermilion by pedicled myomucosal labial vestibular flap in traumatic defect of lower lip

“…The main goal in the lip reconstruction is to have normal looking lip with good sphincteric competence and normal function. Lip malignancy[ 1 ] and roadside accidents[ 7 ] are the common causes of lower lip defects,[ 4 8 ] while other less common causes are burn injuries, animal[ 9 ] and human bite,[ 1 ] fire and cracker blast injuries, A-V malformations,[ 10 ] and cancrum oris. [ 6 ] Vermilion and lip defects are repaired by many techniques described in the literature.…”

The “Frogger Flap”: A Novel Quadruple Rhomboid Flap for Complex Central Upper Lip Reconstruction

“…3 When skin‚ vermillion‚ and less than 50% of the philtrum are involved, a mucosal advancement flap is an additional recommended consideration. 3,4 A lipswitch flap is recommended for defects involving more than 50% of the philtrum instead of full-thickness skin grafting when skin and vermillion are both involved. 3,4 Alternative reconstructive options include wedge excision, local advancement flaps (including O-Z and V-Y flaps), rhomboid/transposition flaps and the Abbe flap.…”

“…3,4 A lip-switch flap is recommended for defects involving more than 50% of the philtrum instead of full-thickness skin grafting when skin and vermillion are both involved. 3,4…”

“…1,2 Current recommendations for the reconstruction of upper lip defects depend on the presence and degree of philtral and vermillion involvement. 3,4 The "Frogger Flap": A Novel Quadruple Rhomboid Flap for Complex Central Upper Lip Reconstruction…”

“…3 When skin‚ vermillion‚ and less than 50% of the philtrum are involved, a mucosal advancement flap is an additional recommended consideration. 3,4 A lip-switch flap is recommended for defects involving more than 50% of the philtrum instead of full-thickness skin grafting when skin and vermillion are both involved. 3,4…”