Modified Flap Design for Symmetric Reconstruction of the Apical Triangle of the Upper Lip

Abstract

Background The apical triangle is the superior portion of the cutaneous upper lip lying between the medial cheek and alar margin. Defects involving this subunit are often repaired without taking into consideration the aesthetic implications of its potential loss or reduction. We present a simple option for repair of apical triangle defects to address this concern. Methods We collected a series of 69 patients with apical triangle defects treated from 2002 to 2008 with Mohs micrographic surgery. Their defects were reconstructed using various flaps (advancement, rotation, island pedicle, or M‐plasty). A subset of 27 patients was identified who had undergone a standard cheek advancement flap or a modified flap. The modified design introduces an incision extending from the alar crease onto the nasal sill along the cutaneous upper lip, creating a second sliding flap to assist in recreating the apical triangle. Results A modified flap design introduced the ability to transfer adjacent tissue of the cutaneous upper lip to reconstruct the apical triangle subunit. Conclusion This flap modification is a simple and efficient method of repairing peri‐alar defects that restores the apical subunit, preserving facial symmetry.

Pursuing symmetry in reconstruction of the upper lip apical triangle with a hatchet flap

“…It is noted that the scar line between the oral commissure and the nasolabial fold may be more evident and challenging, especially in younger patients. Our search of the literature found a melolabial rotation flap performed by Orangi et al [4] and a modified flap performed by Johnson-Jahangir et al [5] for the reconstruction of the apical triangle. Although both studies present satisfactory results, some caveats, such as the importance of extending the flap to the commissure to gain tissue and to avoid a decrease, are absent.…”

Repair of a Multisubunit Defect of the Cheek, Nose, and Lip

“…The lower V-Y advancement flap was used to reconstruct the upper cutaneous lip with hair-bearing skin, with the leading tip of this flap used to repair the lateral ala. 2 The upper V-Y advancement flap was used to reconstruct the cheek and lateral nasal sidewall. 3,4 Curvilinear incisions of the 2 flaps camouflaged within the vermilion-cutaneous junction, melolabial fold, and relaxed skin tension lines of the cheek.…”

Midface Composite Defect: Laterally Based Bilobed Flap As a Platform for a 3-Stage Folded Paramedian Forehead Flap

“…Templates from the contralateral upper cutaneous lip subunit provided a guide for positioning the re‐created lateral alar groove while the contralateral alar sill also provided a useful landmark. The combination of the bilobed and forehead flaps allowed preservation and restoration of the alar‐facial sulcus and the apical triangle of the upper lip …”

“…The combination of the bilobed and forehead flaps allowed preservation and restoration of the alar-facial sulcus and the apical triangle of the upper lip. 3,4 Stage 2 of Nasal Ala Reconstruction-Intermediate Contouring of Folded Forehead Flap and Placement of Free Cartilage Graft, then Division and Inset An intermediate stage was necessary to contour the bulky folded forehead flap and to place a free cartilage alar batten graft between the newly vascularized mucosa and forehead flap. Contouring of the standing cone of the bilobed flap along the vermilion-cutaneous junction was also performed.…”