Abstract
Importance: Reconstruction of small to medium lower lip defects commonly includes mucosal advancement and wedge excision with primary closure, resulting in aesthetic complications such as lip flattening, shortening, and loss of the vermilion roll. The myomucosal lip island flap offers an alternative that preserves lower lip appearance and function.Objective: To describe the lateral myomucosal lip island flap and its indications for the reconstruction of small to medium lower lip defects.Design, Setting, and Participants: A retrospective chart analysis of patients from 2014 to 2019 was done. Participants include all consecutive patients of the senior author who had the myomucosal lip island flap employed in the lower lip from 2014 when the senior author began employing this technique, including 20 patients. Patient demographics, surgical indications, surgical defect bridging distances, flap advancing distances, functional complications, and aesthetic outcomes were reported. IRB approval was obtained from St. Joseph Health Center for Clinical Research and surgeries were performed at a private tertiary referral center—Skin Cancer and Reconstructive Surgery Center—by the senior author in a multispecialty practice.Main Outcomes and Measures: Location and flaps utilized to reconstruct the defect were reported. Lateral advancing distance and overall bridging distance were measured. Functional complications, if any, were reported. Appearance rating after the first stage was assessed.Results: This case series included 20 patients with lower lip defects reconstructed with myomucosal lip island flaps. The average bridging distance (width of defect) was 1.7 cm (minimum 1.0 cm, maximum 2.8 cm). Of 18 patients with available postoperative photographs, 4 cases (22%) had mild vermilion inferior retraction, 1 case (6%) had mild contour irregularity, and 1 case (6%) had visible white scar in the red lip.Conclusions and Relevance: The myomucosal lip island flap is a reliable technique for reconstruction of small to medium lower lip defects, preserving lip fullness and the vermilion roll.
Highlights
Reconstruction of superficial lower lip defects inside the vermilion line has traditionally been performed with mucosal advancement
Our definition of combined techniques only included those that were used in the red lip reconstruction and did not include the flaps used for the cutaneous defect reconstruction
No of flaps used for red lip closure
Summary
Reconstruction of superficial lower lip defects inside the vermilion line has traditionally been performed with mucosal advancement. In the 20th century, several authors have described mucosal advancement in the English language literature.[4,5,6] This technique involves sacrificing surrounding red lip mucosa as the flap is advanced posterior to anterior. The posterior tension of advancement effaces the lip projection at the vermilion border, flattening the aesthetic fullness of the lower lip.[7]. This mucosal advancement was modified by Kolhe and Leonard in 1988,8 to include muscle and inferior labial artery within the leading flap edge. This myomucosal flap advancement lessened vermilion effacement while still sacrificing the surrounding mucosa
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