Vermilion lower lip cross flap - An anatomic study on 22 fresh cadavers

Abstract

Context:Vermilion lower lip cross flap is indicated for reconstruction of upper lip in residual deformities following trauma or cleft lip. Flap survival depends on incorporation of inferior labial artery in pedicle.Aims:This article reports measurement of vertical distance between inferior labial artery and vermilion surface under light microscope in midline sagittal cross-sectional specimens harvested from 22 fresh male cadavers, to design cross lip vermilion flap more accurately and reduce morbidity of donor site.Settings and Design:This study is designed to measure vertical distance between uppermost parts of inferior labial artery to vermilion surface in 22 fresh male cadavers. Tissue specimens were taken from lower lip midline in sagittal plane. Histological sections stained with Hematoxylin-eosin were reviewed by Pathologist.Materials and Methods:Measurements were done by staged micrometer which was calibrated in 10 μm subdivisions under light microscope. Vertical distance was measured in millimeter and artery location was defined as submucosal, in superficial muscle and deep muscular layer.Statistical Analysis Used:Descriptive study.Results:Analysis of data shows that mean distance was 2.42 ± 1.67 mm. In 77.27% of cases, the artery was in submucosal layer and in 13.64% of cases this artery was located in superficial muscular layer.Conclusions:As a result 4-mm depth incision of lower lip vermilion that incorporate superficial layer of orbicularis oris muscle will ensure blood supply of lower lip vermilion cross flap.

An Aesthetic, Functional, and Low-Invasive Lower Red Lip Reconstruction Using a Mucosal Perforator Flap: A Case Report

“…7 Traditionally, various techniques have been used to reconstruct the lower lip, ranging from simple direct closures to local or distant flaps, including vermilion advancement flaps and Abbe-Estlander flaps. 8 The appropriate reconstructive technique is selected according to the defect in each case; for example, a simple direct closure is appropriate for a relatively small defect, affecting less than 1/3 of the lip, while the Abbe-Estlander flap is useful for the reconstruction of a relatively large defect, affecting 1/3 to 2/3 of the lip, although there is no 'gold standard'. 9 Therefore, modified conventional reconstructive techniques have also been reported.…”

An esthetic, functional, and low‐invasive lower red lip reconstruction using a mucosal perforator flap: A case report

“…The lower lip is not only important regarding function, such as feeding and speech, but it is also a component of the face and, therefore, must be reconstructed with a good esthetic appearance 7 . Traditionally, various techniques have been used to reconstruct the lower lip, ranging from simple direct closures to local or distant flaps, including vermilion advancement flaps and Abbe and Estlander flaps 8 . The appropriate reconstructive technique is selected according to the defect in each case; for example, a simple direct closure is appropriate for a relatively small defect, affecting less than 1/3 of the lip, while the Abbe‐Estlander flap is useful for the reconstruction of a relatively large defect, affecting 1/3–2/3 of the lip, although there is no “gold standard.” 9 Therefore, modified conventional reconstructive techniques have also been reported 2,10 .…”

“… 7 Traditionally, various techniques have been used to reconstruct the lower lip, ranging from simple direct closures to local or distant flaps, including vermilion advancement flaps and Abbe and Estlander flaps. 8 The appropriate reconstructive technique is selected according to the defect in each case; for example, a simple direct closure is appropriate for a relatively small defect, affecting less than 1/3 of the lip, while the Abbe‐Estlander flap is useful for the reconstruction of a relatively large defect, affecting 1/3–2/3 of the lip, although there is no “gold standard.” 9 Therefore, modified conventional reconstructive techniques have also been reported. 2 , 10 In 2009, Oki et al reported a case of one‐stage reconstruction of the upper lip using an inferior labial artery pedicled island flap, a modification of the Abbe flap, which generally requires two surgeries.…”

Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects

“… 27 The HLA branches from the facial artery in the middle of the lower lip and the inferior labial artery branches at the level of the oral commissure. In most cases, the HLA runs under the depressor anguli oris muscle and passes through the depressor labii inferioris and orbicularis oris muscles 28 , 29 and can be preserved in the lower lip inferior to the oral commissure, and inclined gradually toward the lower lip. Careful dissection with precaution of variance in anatomical landmark will assure flap viability and avoid injury to these vessels.…”