Vermilion Flap Research Articles

Cross Lip Vermilion Flap and Traumatic Upper Lip Avulsion: Reducing Donor Site Morbidity.

Using a cross lip vermilion flap for upper red lip reconstruction in cases other than whistle deformity in patients with cleft lip can lead to donor site morbidity. If the practitioner performs primary closure of the mucosa in lower vermilion after flap harvesting, the width and height of lower lip are reduced, which results in an increased lower incisor tooth show. Using free fat grafting is an effective method for reducing donor site morbidity in the lower lip following cross lip vermilion flap harvest.

Bilateral cleft lip repair by new trending method: a case report

BackgroundBilateral cleft lip repair is one of the most difficult surgeries, and many techniques have been modified and developed to improve surgical outcomes. The current trend is toward preserving tissue as much as possible. When the reconstruction is based on the shape of the patient’s own tissue, the most natural appearance is produced, and the relaxed remaining tissue can be benefitted from reducing tension and minimizing scarring.Case presentation.In the conventional surgical method, the rest of the prolabium is sacrificed, except for the tissue used to make the philtrum. We used all tissues for surgery and did not discard any. The tubercle of the median vermilion was used in its original form.ConclusionsIt is fundamental to restore function in cleft lip surgery. Both patients and surgeons have a desire for esthetic outcomes that go beyond function. In addition, the measure of the success of the surgery is the postoperative resemblance to normal midfacial features. Unlike the conventional method of making tubercles by collecting lateral vermilion flaps, we preserved the tissue of the prolabium. Rather than using an artificial tubercle, we were able to create a more natural shape of the upper lip using the patient’s own anatomical structure. In addition, the remaining tissues of the discarded prolabium were used to make the oral mucosa, which may help to reduce tension compared to the conventional method. The modified repair method is expected to gradually become the mainstream method owing to its superior esthetic outcome and less surgical difficulty compared with traditional methods.

Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height.

Background:Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry.Methods:Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut “poker incision” to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry.Results:Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], P = 0.56), demonstrating satisfactory upper lip symmetry.Conclusions:Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry.

A Prospective comparative Study of Vermilion repair by Modified Vadvancement Vermilion Flap in Unilateral Cleft Lip Patients

Abstract Background Oro-facial clefts include a range of congenital deformities most commonly presenting as cleft lip with or without cleft palate (CLP) or isolated cleft palate (CP). CLP is the second most common congenital birth defect in the U.S. Aim of the Work to assess modified v-advancement vermilion flap combined with Tennison technique for vermilion repair in unilateral cleft lip regarding aesthetic outcome in comparison with repair of cleft lip by Tennison technique. Patients and methods This study was conducted in plastic, maxillofacial and reconstructive surgery department in Ain Shams University between September 2019 to February 2020. It included 20 patients divided into two group; the first group consisted of 10 patients who underwent repair of cleft lip by Tennison technique and the second group consisted of 10 patients who underwent repair by Tennison technique combined with v- advancement vermilion flap. Both groups were assessed postoperatively by Asher-McDade et. al. scoring system. Result The study showed statistically significant difference between the two groups as regard the white lip length which was more symmetrical in cases repaired by Tennison technique combined with modified v-advancement vermillion flap (P = 0.01). The bulge and the deficiency in the lateral vermilion were decreased in the group treated by Tennison technique with modified v-advancement vermilion flap. However the difference was statistically insignificant (P = 0.66). Conclusion The choice of a technique for surgical correction of UCL should be based on an evidence that this technique has the best functional and aesthetic outcomes. The findings of this study support the view that these two methods of cleft lip repair have their own advantages and disadvantages. Tennison technique combined with vadvancement vermilion flap achieved less bulge in the vermilion with no statistically significant difference.

A modified method for corner mouth lift in scar-prone patients.

Corner mouth lift is in increasing demand among young patients in East Asia. Although various surgical methods exist for corner mouth lift, many patients are reluctant to undergo surgery due to fears of postsurgical scarring. We present a new technique aimed at reducing postoperative scarring. The technique involves triangular excision of the corner of the mouth and incision of the commissure with transposition of a lateral vermilion flap to lift the corner of the mouth. The muscle around the corner of the mouth is dissected to release tension. The corner mouth lift was successfully performed in all patients. It can be effectively used even in patients, such as young Asian women, who are susceptible to hypertrophic scars.

Managing lip large papilloma extirpation defect by arterialized advancement vermilion flap

The close resemblance of squamous papilloma with verrucous carcinoma and the chief etiological factor associated with its development, the human papillomavirus (HPV) raises a doubt about its close association with malignancy. The best way to treat HPV growths is surgical removal and assessment of lesion by histopathology. The defect needs reconstruction with full function and aesthetic outlook. Thirty-seven years old young man with history of tobacco chewing developed slow growing papilloma in upper lip in one year. It was excised fully and the defect was repaired by arterialized lip vermilion mucosal flap based on slightly tortuous labial vessel and so the flap could be elastically stretched even up to fifty percent of lip length and applied successfully. Same patient developed papilloma in lower lip as a separate primary after two years of nonrecurrence of previous operated upper lip papilloma. Lower lip lesion was excised similarly and repaired with same type of vermilion mucosal advancement flap from adjacent part of lower lip defect created. The post-operative period was uneventful and after three years of last operation there is no recurrence in either lip. Vermilion flap which is based on labial artery containing composite tissue comprising of mucosa and portion of orbicularis muscle mainly has been utilized to reconstruct the post excision papilloma lip defect with excellent functional and aesthetic results. There was no microstomia. It is single stage not involving donor site like tongue or cheek mucosa and is good upto half of lower lip defects.

Objective evaluation of vertical Z-plasty with double transposition vermillion flaps for secondary whistling deformity correction: A method for uni- and bilateral correction

ObjectivesThis study describes a modified method for secondary correction of whistling deformities in patients with unilateral and bilateral cleft lip/palate (CL/P), using a horizontal double transposition vermilion flap, including parts of the orbicularis oris muscle. The pre- and postoperative results were objectively evaluated. Study design34 patients with a whistling deformity who underwent secondary reconstruction between 07/2013 and 11/2018 were included in this study (mean age 20.2 ± 11.6 years). 24 patients were male and 10 female. 30 patients presented with cleft lip and palate (CLP) — 15 bilateral, nine on the left side and six on the right. Four patients had only a left-side cleft lip (CL).The whistling deformity reconstruction was carried out using two triangular transposition vermilion flaps with muscle parts, for a vertical Z-plasty. The surgical procedure is normally performed under local anesthesia in all patients older than 10 years. For statistical evaluation, the size of the whistling defect in the vermilion was determined on photographs before and 6–9 months after surgery. The individual defect score (DS) was evaluated pre- and postoperatively. In all patients, no additional surgical procedures, such as rhinoplasty or scar correction in the upper lip, were carried out simultaneously. ResultsMinor (DS < 400), moderate (DS 400–1400), and severe (DS > 1400) whistling defects were surgically corrected. The whistling defect score was significantly reduced in all patient groups (p < 0.001). In six patients the result of surgery was rated as 'acceptable' (DS > 30), in five patients as 'good' (DS 10–30), and in 23 patients as 'very good' (DS 0–10). ConclusionsThis study describes a modified method for whistling deformity reconstruction in uni- and bilateral clefts. The aesthetic results are based on a reconstruction of the subcutaneous muscle layers and the creation of a symmetrical lip contour and prolabium using transposition flaps from the lateral side of the cleft. The great advantage is the uncomplicated performance under local anesthesia, even for all children over 10 years, and the short operation time. Postoperative complications did not occur.

A Foxtail-Shaped Vermilion Flap to Reconstruct the Medial Tubercle in Asymmetric Bilateral Cleft Lip With Contralateral Lesser Form Defect.

There have been few reports addressing asymmetric bilateral cleft lip repair with contralateral lesser form defects. Two studies have described the thin medial tubercle as the most common remaining labial deformity. In this study, we aimed to evaluate the use of a foxtail-shaped vermilion flap to reconstruct the median tubercle in primary repair. A blinded retrospective study of photography and chart review. Shinshu University Hospital, tertiary care. Private practice. Forty-nine patients with asymmetric bilateral cleft lip with lesser form defects treated using a primary "unilateral" repair by the senior author (S.Y.) between 2007 and 2017. The foxtail-shaped vermilion flap was applied at the time of the primary nasolabial repair. This flap is similar to Noordhoff laterally based triangular vermilion flap but with modifications to the shape and length. The body of the flap is wider than the pedicle to add tissue to the center of the vermilion, and the length is sufficiently elongated to reach the lesser side. Lip shape was graded on a 4-point scale when patients were 1 year old. Twenty-two patients were treated with the foxtail-shaped vermilion flap (group A) and 27 patients with Noordhoff triangular vermilion flap (group B). Group A had a better lip shape than group B (P = .006). The foxtail-shaped vermilion flap is useful to reconstruct the median tubercle in asymmetric bilateral cleft lip repair with contralateral lesser form defects.

Reconstruction of the oral commissure in patients with unilateral transverse facial cleft

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013–2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.

Four Patients Undergoing Labioplasty and Lip Reconstruction for Lip Deformity

We managed four patients who had neoplastic, posttraumatic, atrophic and postoperative lip deformity, respectively. Case 1: The patient had a hemangioma (17 × 14 mm) confined to the vermilion part of the lower lip. We performed the wedge excision of the tumor and labioplasty. The postoperative appearance and function of the lip were satisfactory. Case 2: The patient had posttraumatic deformity of the upper lip. We performed correction by Cronin’s triangular flap method. The postoperative appearance of the lip was satisfactory. Case 3: The patient had severe atrophy of the upper lip and difficulty closing mouth due to progressive hemifacial atrophy. We performed reconstruction of the upper lip on the atrophic side with a cross-lip vermilion flap from the non-atrophic lower lip. The postoperative appearance and function of the lip were satisfactory. Case 4: The patient had postoperative lower lip deformity and difficulty closing mouth after tumor resection and reconstruction with a myocutaneous pectoralis major flap. We performed debulking of the bulky flap and covered the raw surface with a local rotation flap. The postoperative lip closure was satisfactory. In patients with lip deformity, it is important to perform appropriate correction or reconstruction according to each patient’s clinical features in order to achieve satisfactory cosmetic and functional outcomes.

Improving the Results of Cross Lip Vermilion Flap in Cleft Patients.

Cross lip vermilion flap is a myomucosal flap that uses lower red lip to augment deficient upper lip vermilion. Technical note that helps in imitating upper lip tubercle structure is presented. Appropriate patient selection to prevent unfavorable results such as color mismatch, local vermilion excess, and lower lip thinning are presented. Indirect benefits of this flap for decreasing upper incisor tooth show and better balance of upper/lower lip thickness are discussed.

進行性顔面半側萎縮症患者の上唇変形をCross-lip vermilion flapで再建した1例

進行性顔面半側萎縮症患者の上唇変形をCross-lip vermilion flapで再建した1例

A case of reconstructed unilateral upper lip deformity due to progressive hemifacial atrophy with a cross-lip vermilion flap

A case of reconstructed unilateral upper lip deformity due to progressive hemifacial atrophy with a cross-lip vermilion flap

Reconstruction of the 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap

To investigate the reconstruction of 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap pedicled at oral commissure. At the first stage, the lower lip mucosal flap pedicled by inferior labial artery was transposed to reconstruct the defect on upper lip vermilion and tubercle. The defect at the donor site was closed directly. At the second stage, the flap pedicle was cut off and revised. 6 patients were treated with satisfactory aesthetic results. All the flaps survived completely. The oral commissure kept normal with no obvious scar at the donor sites. The modified crosslip vermilion flap pedicled at oral commissure has the advantages of avoiding inconvenience in feeding, speaking and cleaning. The procedure is simple with available blood supply. Both aesthetic and functional results are satisfactory.

Lateral vermilion border transposition flap to correct vermilion deformities with unilateral or bilateral cleft lip

Previously, bilateral lateral vermilion border transposition flaps were reported to correct whistling lip deformity in patients with cleft lip. This study examined the long-term outcome in these patients and modified the procedure. Here, the use of this procedure is reported in 69 cleft lip patients. The follow-up period after the operation ranged from 4–14 years. In addition to the standard method, a unilateral flap was applied for asymmetrical vermilion and small bilateral flaps were applied to loosen the transverse tightness of the vermilion. The asymmetry of the tightness was improved in all patients. The reconstructed tubercle diminished in volume gradually over a few years postoperatively. Secondary deformities after its use were subtly everted tubercle during smiling (18.8%) and irregularities on the labial-free margin (21.7%). They were corrected by minor follow-up revision. Although it is necessary to wait several years until the postoperative shape has stabilised, this is a simple and widely available method to reconstruct a naturally-shaped vermilion in cleft lip patients.

Upper-lip vermilion reconstruction with a modified cross-lip vermilion flap in hemifacial atrophy

Lip-vermilion reconstruction is part of the comprehensive treatment of progressive hemifacial atrophy. In this study, we described a two-stage reconstruction procedure to address the defect of the upper lip in patients with hemifacial atrophy, using a modified cross-lip vermilion flap with the pedicle specifically positioned at the commissure for functional and aesthetic purposes. During the first stage of surgery, a pre-determined mucosal flap from the lower lip with a vascular pedicle containing an inferior labial artery and the surrounding orbicularis oris muscle cuff were raised and transposed to reconstruct the upper-vermilion defect. Additional manoeuvres include simultaneous creation of the central tubercle of the upper lip with a segment of de-epithelised vermilion flap. At the second stage, the pedicle was divided 10-14 days later to complete the reconstruction. The patients achieved satisfactory results without compromising the shape of the commissure and the donor-site scar was inconspicuous. During the period prior to the division of the pedicle, this technique also overcomes the discomfort and pain during eating and speaking that could occur with the traditional cross-lip vermilion-flap transfer whereby the pedicle is centrally located. To the best of our knowledge, this is the first report of such a technique specifically applied to address the unilateral upper-lip vermilion defect in patients with hemifacial atrophy.

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

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.

Dandy Walker Syndrome with Tessier 7 Cleft-a Rare Case Report and a Surgical Note on the Use of Vermilion Flap and Lazy W-Plasty

The Dandy-Walker syndrome is a malformation of the brain that involves the mal-development of the cerebellum, associated with a cystic enlargement of this area, and frequently hydrocephalus. This malformation occurs in ~1 in 30,000 babies. It is seen mostly in females. Developmental anomalies like cleft lip, cleft palate, and cardiac malformation, orthopaedic and urinary structural abnormalities may also occur in 30% of the individuals. We report a case of Dandy Walker syndrome with Tessier 7 facial cleft with paramedian cleft palate in a 6month old child. Surgical methods used to correct this anomaly include commissuroplasty, myoplasty of the orbicularis oris, and closure of the cleft cheek. Authors report a vermilion square flap technique that combines a lower lip mucocutaneous vermilion border flap with a lazy W-plasty to ensure a natural commissure and skin closure.

The ‘Dirty Lip’ Trick

The lips are complex anatomical structures with significant psychosocial and functional importance. The wet-dry line or ‘red line’ on the lip represents the transition from oral mucosa to lip vermilion, and is one of the essential anatomical landmarks required for accurate reconstruction of the lip. Identification of the wet-dry line is important in cleft lip surgery, particularly if a triangular vermilion flap from the lateral element is used to augment the deficient vermilion on the medial side, as described by Noordhoff (1). During lip surgery, landmarks and presurgical marking are often distorted by intraoperative edema and local anesthetic infiltration; standard methods for maintaining these landmarks in the cutaneous lip, such as tattooing, are not as effective in the vermilion. The authors present a simple yet effective way of identifying the red line during surgery. The immediate response when attempting to identify the wet-dry junction is to clean the lip of any dried blood for better visualization. The authors simply suggest leaving the lip ‘dirty’; the blood adheres to the wet mucosa and not to the dry, thus clearly and consistently identifying the junction between wet and dry mucosa (Figures 1A and ​and1B1B). Figure 1) A and B Leaving the lip ‘dirty’ during cleft lip surgery clearly identifies the division between wet and dry vermilion The authors have been surprised at how often such a simple technique has been useful in cleft and other forms of reconstructive lip surgery.

Bilateral Cleft Lip and Nasal Repair

The bilateral cleft lip and nasal repair has remained a challenging endeavor. Techniques have evolved to address concerns over unsatisfactory features and stigmata of the surgery. The authors present an approach to this complex clinical problem that modifies traditional repairs described by Millard and Manchester. The senior author (H.S.B.) has developed this technique with over 25 years of surgical experience dealing with the bilateral cleft lip. This staged lip and nasal repair provides excellent nasal projection, lip function, and aesthetic outcomes. Lip repair is performed at 3 months of age. Columellar lengthening is performed at approximately 18 months of age. A key component of this repair focuses on reconstruction of the central tubercle. A triangular prolabial dry vermilion flap is augmented by lateral lip vermilion flaps that include the profundus muscle of the orbicularis oris. This minimizes lateral lip segment sacrifice and provides improved central vermilion fullness, which is often deficient in traditional repairs. The authors present the surgical technique and examples of their clinical results.