Vermilion Tubercle Research Articles

Repair of Asymmetric Bilateral Cleft lip: 1 Stage or 2 Stage.

To verify the advantages and indications of 1-stage and 2-stage repair for asymmetric bilateral cleft lip (BCL). Retrospective study. From January 2004 to December 2016 in our department. Patients with BCL. Over 6 months after the operation, the surgery outcomes were evaluated and graded by 2 experienced surgeons. The result of surgery was evaluated using the scoring method of Mortier et al and Anastassov and Chipkov. Among 133 patients with asymmetric BCL, 61 (45.9%) had 1-stage repair and 72 (54.1%) had 2-stage repair. Sixty-eight (51.1%) patients had complete-incomplete cleft lip (CL), and those who underwent 1-stage repair showed a trend of better outcome (P = .028). Fifty (37.6%) patients with incomplete-microform CL showed no significant difference between the outcomes of 2 surgery plans (P = .253). In 15 (11.3%) patients with complete-microform CL, only one had 1-stage repair with a score of 8.5. The other 14 patients with 2-stage repair were scored 3.68 ± 1.28. Two-stage repair was preferable when the deformity degree was very different on 2 sides, as it could reduce unnecessary scar tissue and extend the nasal columella. One-stage repair could help to achieve the anatomical reduction of the orbicularis oris and a better contour of the vermilion tubercle. One-stage repair is recommended for patients with complete-incomplete CL and incomplete-microform CL. Two-stage repair for patients with complete-microform CL is preferred in our center, but more studies are required to support this conclusion.

Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip

PurposeTo demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction. MethodsThe surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method. ResultsFinite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up. ConclusionForce balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.

Efficacy of repair of bilateral complete cleft lip and nasal deformity by 3dMD face system

Objective To assess the effectiveness of the Mulliken＇s method in bilateral complete cleft lip patients with 3dMD system and anthropometric landmarks. Methods Thirty-one infants with bilateral complete cleft lip received treatment in Hospital of Stomatology, Wuhan University between January 2014 and December 2016. Patients underwent primary cheiloplasty and nasoplasty by the same senior surgeon. Periodic review was taken to measure and record the 7 items in the nasolabial area with three-dimensional (3D) images. Results The labial and nasal deformities were restored after primary surgery. The upper lip and nose were corrected and obtained the symmetric shape. The columella was elongated to acquire favorable nasal tip. The arc of nasal fornix was upward. The ridge of the white lip was continuous and integrated with full vermilion tubercle. Total length of upper lip (Sn-Sto), thickness of the vermilion tubercle (Ls-Sto), protrusion of the nasal tip (Nh) and columellar height (Ch) were markedly improved and there were no significant difference between the observation group and the control group. The significant differences between two groups occurred in values of the nostril width (Nw), which was greater than control group and white lip height (Sn-Ls) and lower than that of control group. Conclusions Mulliken＇s method during the primary cheiloplasty of the bilateral complete cleft lip shows better results in correction the nasal deformity and the ideal effects are achieved during follow-up. Key words: Cleft lip; Reconstructive surgical procedures; Bilateral complete cleft lip; Mulliken＇s method; 3dMD; Labial and nasal deformity synchronous repair

Cleft lip secondary repair: evaluation and description of the method of orbicularis oris three uints

Objective Secondary deformities are common in people born with unilateral cleft lip and palate. In recent years, more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy. The authors present a new method of orbicularis oris repair in secondary cleft lip repair. Methods From July 2009 to December 2011, 24 patients underwent this procedure in the authors' department. Muscle reconstruction was divided into three units that dealed with the nasal base, white lip and red lip. Common anatomic pathologies including the displacement of upper lip, flared ala, blunted ala-facial groove, depressed nasal floor, lateral bulge, lack of philtrum column, free border deficiency and unapparent vermilion tubercle were corrected in a single operation. Results The average follow-up period was 16.79±6.23 months. No major complications occurred. All the patients were satisfied with their nasolabial appearance. Conclusions Three-unit muscle repair has found to be effective and practical in secondary repair. Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure. Key words: Cleft lip; Secondary treatment; Orbicularis oris muscle; Three units

Modified Abbé flap for reconstruction of Cupid's bow and vermilion tubercle in secondary cleft lip deformity.

Background Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid’s bow and central vermilion tubercle with minimal sequalae.Methods From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid’s bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation.Results Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid’s bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional Abbé flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile.ConclusionA new modified Abbé flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid’s bow.

Correction of whistle deformity in bilateral cleft lip with lower lip bipedicle orbicularis oris musculomucosal island flap

To explore a new method to correct the whistle deformity in bilateral cleft lip. A lower lip bipedicle orbicularis oris musculomucosal island flap was designed to repair the upper vermilion defect.The pedicle of this flap was deepidermidalized and then embedded into the upper lip. The dry lip in the central was reserved to reconstruct the vermilion tubercle. From Aug.2013 to Aug.2015,10 cases were treated successfully with primary healing. With the follow-up period of 5-17 months, the appearance of upper lip was greatly improved with a balanced proportion and full lip tubercle. This lower lip bipedicle orbicularis oris musculomucosal island flap is an ideal method for the correction of whistle deformity in bilateral cleft lip.

Secondary correction of deformities of the lip with subdermal soft tissue flaps after bilateral cleft lip repair

Objective To explore a new method to correct nostril-bottom deformities and whistle deformity of secondary deformities of bilateral complete cleft lip (BCCL). Methods Bilateral subdermal soft tissue c flaps and d flap were designed to repair secondary deformities of nostril-bottom and vermilion tubercle in patients with bilateral complete cleft lip (BCCL). Results The good healing was found in all the cases. No flap necrosis was noted. The result was satisfactory in the 23 patients that had been followed up more than 8 months; 5 were very satisfied with their results, whereas sixteen patients graded their results as good. Conclusions With bilateral subdermal soft tissue c flaps and d flap, nostril-bottom deformities and whistle deformities can be corrected with definite and good efficacy. Key words: Bilateral cleft lip; Surgical flap; Postoperative deformity of cleft lip; Orbicularis oris muscle

Synchronous correction of lip and nasal deformity in complete bilateral cleft lip

To investigate the technique and its therapeutic effect of synchronous correction of lip and nasal deformity in complete bilateral cleft lip. 29 patients with complete bilateral cleft lip underwent synchronous correction of lip and nasal deformity with the modified Mulliken method for Asians. The philtral flap was 6-7 mm in length, and 3-4 mm in width at the collumellar-labial junction. The distance between the peaks of cupid's bow was 4-5 mm. The bilateral edge of philtral flap was de-epithelialized and advanced to form philtrum column. The lateral lip was advanced to the medial site, and the central vermilion tubercle was constructed with the bilateral vermilion-mucosal flap. Through the alar rim incision, the displaced cartilage was dissected and repositioned to raise the nasal tip. The follow-up period was 6 months to 6 years. Satisfactory results were achieved in all patients. The reconstructed upper lip had invisible scar with natural philtrum and column. The vermilion had good appearance with tubercle. The length of nasal column was not decreased and depression of nasal tip and alar was greatly improved. Our modified Mulliken method is effective in synchronous correction of lip and nasal deformity in bilateral cleft lip.

Application of upper-lip lifting procedure in perioral rejuvenation

Objective To illustrate a method of lifting the upper-lip to alleviate the aging face, and to evaluate its effects and risks. Methods In the past two years, 53 cases of overlong upper-lip were performed with this procedure. The recovery periods, lifted effects, side effects and the total satisfactions were evaluated. Results As for recovery periods, edema roughly reduced in 6-20 months, reddish scar faded in 1-11 months, expression restored in 2-8 months, and numbness disappeared from 4 to over 18 months. The lifted effects showed that 37 cases (78.7%) were satisfactory, 7 cases (14.9%) of the lifting was not enough and still complained a long upper-lip, 2 cases (4.2%) was ineffective, and 1 case (2.1%) considered an excessive lifting. The long-term follow-up showed that 3 cases (6.4%) had obvious scar (visible at a distance of more than 1 m), 14 cases (29.8%) had depression of columella/base of nostril alar or with increased exposure of nostril, 3 cases (6.4%) had expansion or morphological changes of alar, 6 cases (12.8%) had increased thickness of the upper lip and prominent vermilion tubercle, 1 case (2.1%) had changes of expression, 1 case (2.1%) had asymmetry, 1 case (2.1%) had arching sagging, and 35 cases (74.5%) had numbness or insensitivity of upper-lip. Overall results showed very satisfied in 29 cases (61.7%), satisfied in 15 cases (31.9%) and dissatisfied in 3 cases (6.4%). Conclusions The technique for upper-lip lifting displays a significant effect with few complication. It is recommended for further clinical application. Key words: Perioral rejuvenation; Overlong upper-lip; Upper-lip

“Three-Unit” Muscle Reconstruction in Secondary Cleft Lip Repair

Background : Secondary deformities are common in people born with unilateral cleft lip and palate. In recent years, more and more attempts and efforts have been directed toward muscle reconstruction. The authors present a new method of orbicularis oris repair in correction of secondary cleft lip deformities. Methods : From April 2009 to April 2013, a total of 28 patients underwent this procedure in the authors' department and had a follow-up with a minimum length of 1 year. Muscle reconstruction was divided into three units that deal with the nasal floor, white lip, and red lip. Common anatomical pathologies including a deviated columella, blunted alar-facial groove, lack of philtral column, "free border" deficiency, and unapparent vermilion tubercle can be corrected in a single operation. Results : The average follow-up period was 14.6 months (range, 12 to 24 months). Contractubex gel (Merz Pharma, Frankfurt, Germany) was used to treat prominent or reddish scars in 16 patients. No major complications occurred. All the patients were satisfied with their nasolabial appearance. Conclusions : "Three-unit" muscle repair was found to be effective and practical in secondary repair. Improved aesthetic and functional results can be achieved with this comprehensive procedure.

A method for reconstruction of vermilion tubercle.

Background:This article reports on the bilateral lip mucosa flaps (BLMFs) for reconstruction of the vermilion tubercle of the corrected cleft lip deformity.Methods:From 2005 to 2013, the bilateral mucosa flaps procedures were performed on 34 secondary cleft lip patients (bilateral, n = 25; unilateral, n = 9). We retrospectively reviewed the pre-, intra-, and postoperative data of these 34 cases receiving BLMFs.Results:Satisfactory results were obtained, both cosmetically and functionally, in all 34 patients. Lateral projection measurements of the reconstructive vermilion tubercle showed a mean increase of 151%. There were minimal perioperative complications. The color and texture matched well with the surrounding tissue. The postoperative scars are not remarkable at all.Conclusions:The technique is relatively simple. The BLMFs provided a versatile and reliable option for the reconstruction of the vermilion tubercle from secondary cleft lip deformities.

The Application of Bilateral Lip Mucosa Flaps in Repairing Upper Vermilion Defects

The lip is a primary aesthetic feature of the human face. Repair of vermilion defects represents a unique challenge to the reconstructive surgeon. The methods of repair are various and have both advantages and disadvantages. Bilateral lip mucosa flaps were applied to the repair of upper vermilion defects, and the effects were observed and reported in this article. The bilateral lip mucosa flaps were designed. Two reverse triangular flaps were designed on both sides of the upper vermilion defect. These 2 flaps have the common pedicle in the vermilion depression site. Alternatively, a "λ" incision may be used in the wet vermilion. Then, the mucosa flaps were raised, and the dissection was performed between the orbicularis oris muscles and oral mucosa glands. Next, the bilateral mucosa flaps were rotated down 90° and inserted into the "λ" incision to increase the tissue volume of the middle upper lip and deepen the labiogingival sulcus. The common pedicle of the mucosa flaps was formed to the vermilion tubercle, and the incisions were sutured layer by layer. From 2005 to 2010, the bilateral mucosa flaps procedures were performed on 30 secondary cleft lip patients (bilateral, n=22; unilateral, n=8). Lateral projection measurements of the reconstructive vermilion tubercle showed a mean increase of 149%. Satisfactory results were obtained, both cosmetically and functionally, in all 30 patients. There were minimal perioperative complications. The postoperative scars are not remarkable at all. The technique is relatively simple. The bilateral lip mucosa flaps provided a versatile and reliable option for the correction of vermilion defects from secondary cleft lip deformities.

Improved Black procedure in microsurgical repair of bilateralcomplete cleft lip

Objective To discuss the effect of cheiloplasty we designed an improved Black procedure that with microsurgical technique the tissue from lateral lips on the bilateral cleft lip were used to reconstruct the skin of anterior lip and the vermilion tubercle. Methods 36 cases of congenital bilateral complete cleft lip deformity were repaired through improved Black procedure and microsurgical method, including 19 patients with very short prolabium tissue, repairing insufficient skin and vermilion tubercle tissue by fissure lateral lip tissue. Results Following-up for 3 months to 3 years after treatment showed that 36 patients were with normal and symmetrical high of anterior lips, the chubby vermilion tubercles, the natural morphous of labial archs, the appropriate strength of labrums and the vermilion tubercles and lips without color difference, and the effects were satisfactory. Conclusion The improved Black procedure redeems the shortages of traditional Black procedure for the case with bilateralcomplete cleft lip and smaller anterior lip, such as the deficient height of anterior lips, eclabium and inadequate vermilion tubercles. By applying microsurgical technique, the procedure gives better upper lip function and aesthetic effect, and therefore it is worthy to be recommended in clinic. Key words: Bilateralcomplete cleft lip; Improved Black procedure; Repair

Upper Lip Augmentation With Double-Row Subcutaneous Pedicled V-Y Flaps in Möbius Syndrome

Treatment of open-mouth deformity and augmentation of the upper lip were performed using a combination of double-row V-Y mucosal advancement flaps and a V-Y skin advancement flap in 2 cases with Möbius syndrome. The mucosal V-Y advancement flaps were consisted for 2 rows of flaps. The first row was placed near the labial sulcus, including 3 V-Y advancement flaps. These flaps equally provided 3 directional augmentation for each segment of the upper lip. Second row V-Y mucosal advancement flap was used for the augmentation of the vermilion tubercle. In our cases, V-Y advancement flaps were used as subcutaneous based flaps unlike other distally based V-Y flap techniques for the upper lip. Postoperative complications such as scar formation, sensation problems, severe pain, and edema were decreased because of subcutaneous pedicled V-Y flaps. In addition, the relationship between mucosa and orbicularis oris muscle, which is responsible for the fine balance of the vermilion, was maintained with subcutaneous-based flaps. The skin V-Y advancement flap was used both to lengthen the upper lip and to create philtral columns on the upper lip.

Bilobed mucosal flap for correction of secondary lip deformities following cleft lip surgery

Upper lip whistling deformities, asymmetric upper lip thickness and insufficient vermilion tubercle often occur simultaneously in an affected individual. Unfortunately, these deformities cannot be corrected by a single conventional method. Here, we describe a new technique, using a vermilion-bilobed flap, to address the triplex of deformities simultaneously. A total of 30 A Thirty patients were included in this study. Their ages ranged from 10 to 35 years. The flap consisted of two lobes: one lobe of the flap was located at the oral mucosa of the prolabium, which allowed for correction of the whistle deformity as well as augmentation of the vermilion tubercle; the other was located at the vermilion mucosa on the lateral side of the cleft, which effectively repaired oral mucosal defects. Quantitative measurements of the vermilion shape were performed before surgery and 6 months postoperatively. All patients healed well with no complications of the flaps.The gross appearance of the vermilion was significantly improved. Normal tubercles were restored and symmetric profiles of vermilion were achieved. All the patients were satisfied with their final appearance. The bilobed vermilion mucosal flap is a safe technique, easy to perform and effectively corrects the combined secondary deformities associated with cleft lip surgery.

Report of Unilateral Cleft Lip Repaired with the Skin-Vermilion Flap Method

Sir: Between January and December of 2008, this technique has been used in 96 consecutive unilateral cleft lip repairs. Forty-nine were of male and 47 of female patients, and 50 were incomplete unilateral cleft lip and 46 were complete unilateral cleft lip repairs. The patients' ages ranged between 3 months and 15 years, with a mean of 6.5 months. The operative markings are shown in Figure 1. The problem deserving of our attention is the marking of point 12; point 12 is marked just above the cutaneous roll, and then line 12-11 and line 4-6 are of equal length and will meet, line 13-12 and line 3-6 are of equal length and will meet too, and the line 13-12 plus line 12-10 is equal to that of the non–cleft-side philtral column (line 2-5).Fig. 1.: (Above, left) Preoperative sketch of unilateral incomplete cleft lip showing marking points and incision design. (Above, right, and below, left) Preoperative sketch of unilateral complete cleft lip showing marking points and incision design. (Below, right) Postoperative sketch of unilateral cleft lip repaired with the skin-vermilion method.All lines in Figure 1 are operative incisions. A skin-vermilion triangle flap is designed on the affected side of the lateral lip and inserted into the medial lip (line 6-4) to reconstruct a vermilion tubercle and lengthen the vertical height of the affected lip. The affected orbicularis is freed from its upturned insertion in the region of the columellar base, alveolar cleft margin, and alar base, and then the normal anatomical structure of the upper lip is reconstructed by resetting and fixing orbicularis, nasal columella, and nasal alae, and constructing the nasal base (Fig. 1). All of the patients presented good contour of the vermilion tubercle and chubby nasal base. The vertical height of their upper lip, nasal alae, and vermilion were symmetrical between affected and unaffected lateral lips. The technique can be applied to all degrees of unilateral cleft lip (Fig. 2).Fig. 2.: (Above, left) Preoperative markings of unilateral complete cleft lip. (Above, right) The operating incisions have been completed; a skin-vermilion triangle flap with skin, vermilion, and orbicularis has been formed on the affected side of the lateral lip and will be inserted into the medial lip to reconstruct a vermilion tubercle and lengthen the vertical height of the affected lip. Patient is shown preoperatively (below, left) and 7 days postoperatively (below, right).In patients with cleft lip, surgeons are constantly striving for the ultimate goal of achieving a lip and nose of normal form and function by operative repair. Even though we cannot achieve the ultimate goal at present, some achievements have been gained.1–3 For obtaining a normal upper lip and nose, we consider that we must solve two problems. The first is to recover the normal anatomical structure and tissue tension of the upper lip and nose with cleft lip, and the second is to provide an operative design with a minimal scar in the upper lip and a minimal impact on growing maxillae after cleft lip repair. This formed the basis of the described repair. The strengths of this described technique, then, are (1) effective completion of the problem about the affected medial lip deficient in vertical height without an increased incision in the nasal base; (2) application of lateral lip tissue in reconstructing the nasal agger and filling the nasal base; (3) maximum reservation of vermilion tissue, effective prevention of “whistle deformity,” and formation of a fluent red line; (4) minimal scar; and (5) an obvious vermilion tubercle and minimal tension of the upper lip for scarcely abandoning any tissue. The short-term effect of a cleft lip repair with the described technique is very satisfactory, but the long-term result after surgery should be observed by longer term follow-up of more cases. PATIENT CONSENT Parents or guardians provided written consent for use of patient images. Haisheng Yu, M.D. Qian Wei, M.D. Plastic Surgery Nan Ning, China

Application of bilateral lip mucosa flaps for central defect reconstruction of upper-lip vermilion

Objective To investigate the value of the new method with bilateral lip mueosa flaps for central defect reconstruction of upper-lip vermilion. Methods On both sides of the central defect of upper lip vermilion, reverse triangular flaps was designed below the junction between vermilion and mucosal. These two flaps had the common pedicle of vermilion depression site. Incisions of shape were de-signed below the defect area and the flaps included mucosa and submucous tissue. This mueosa flaps were raised and orbicularis otis muscles under the flaps were free moderately. Bilateral orbicularis oris muscles were sutured under the common pedicle of the two mucosa flaps. Then the bilateral mucosa flaps were ro-tated down 90° and inserted into the (λ) shape incisions to increase the tissue volume of the middle upper lip and deepen the labiogingival sulcus. The common pediele of the bilateral mucosa flaps was formed to the vermilion tubercle and then the incisions were sutured layer by layer. Results The technique was per-formed on 26 patients including 18 cases of upper-lip vermilion defect after repair of bilateral cleft lip,4 ca-ses of upper-lip vermilion defect after repair of unilateral cleft lip and 4 cases of congenital malformation. All the lip mucosa flaps survived completely without any complications. The vermilion, tubercle and shape of the lips were satisfactory after all cases were repaired and all incision scars were concealed. Con-clusions Using the lip mucosa flaps transfer to repair vermilion defect with the same tissue can obtain satisfactory appearance. The lip mucosa flaps are ideal for repairing of the lip vermilion defect and recove-ring of the profile of labial arch and vermilion tubercle. It can be used widely in any cases with the central defect of upper lip vermilion. Key words: Lip mucosa flap; Vermilion defect; Repair

Analysis of unilateral complete cleft lip repaired with skin-vermilion flap method

To introduce the skin-vermilion flap method repairing unilateral cleft lip and analyze the curative effect. We repaired 45 cases with unilateral complete cleft lip by designing a skin-vermilion triangle flap in affected lateral lip to reconstruct the vermilion tubercle, solution, resetting and fixing orbicularis oris muscle, columella nasi and lateral angle of alae nasi, constructing basis nasi, and forming agger nasi between April and December of 2008. All the cases obtained primitively satisfactory effect. The average of follow-up was 3.5 months (rang from 1 to 6 months). All the patients presented obvious agger nasi, good contour of vermilion tubercle and chubby basis nasi. their high-lip, alae nasi and vermilion border were symmetrical between affected and unaffected lateral lip. Simple design, less expected tissue dose, little scar and good contour of vermilion tubercle are the characteristic of unilateral complete cleft lip cheiloplasty repaired with skin-vermilion flap method.

The Abbé Island Flap for the Reconstruction of Severe Secondary Cleft Lip Deformities

Primary repair of the cleft lip is often associated with secondary deformities, which require revision and secondary reconstruction. Patients with one or all of the following, a tight lip restricting use of orthodontic appliances, absence of a Cupid's bow, or absence of vermilion tubercle, were treated with the Abbé island flap. A triangular muco-musculo-cutaneous island flap was designed in the central segment of the lower lip. A full-thickness incision of skin, muscle, and mucosa was made in the midline of the upper lip, dividing the lip into two segments, and the island Abbé flap was inserted. One week after surgery, the pedicle of the island flap was divided and the inset of the flap completed. Sixty patients with severe secondary cleft lip deformities (36 males and 24 females) were treated. Good aesthetic and functional results were achieved during 1 to 17 years of follow-up. Insertion of the Abbé flap resulted in release of the tight upper lip and a new, inconspicuous scar. Use of orthodontic appliances was facilitated, and tightness of the tissue, which restricted the expansion of the alveolar process, was eliminated. Adequate tissue was transferred to the upper lip, which improved the bulk of the lip and vermilion tubercle. The retrusion of the midface and the projection of the upper lip were also improved, and the upper and lower lips became better balanced. Donor site morbidities were insignificant. Use of the Abbé flap in selected patients resulted in successful reconstruction of secondary cleft lip deformities.

Modified Abbé flap reconstructing contour of vermilion tubercle and Cupid's bow in unilateral cleft lip patients

目的 探索使用Abbe唇瓣矫正单侧唇裂修复后上唇过紧、唇弓、唇珠不明显和上唇位居下唇后方等畸形的效果.方法在上唇下正中部红唇上方的皮肤几毫米处由上向下切开唇正中全层,并使其向两侧自然移动,其间隙的大小应与缺如的唇珠宽度的距离相等,然后在下唇正中依缺损的幅度画出下唇Abbe唇瓣的大小.一般Abbe唇瓣的宽度为8 mm,长度为下唇的红唇加2～3 mm的白唇在内.依切口线切开唇瓣,以唇动脉为蒂旋转180°插入上唇正中缺损区后,按黏膜、肌层及皮肤分别进行缝合.10 d后Ⅱ期断蒂,修整红唇缘.结果42例受术者均显示了明显的人中嵴、人中凹、唇峰、唇珠和上唇的正常高度和宽度,同时上唇鼻底的瘢痕不明显,恢复了上下唇前后的正常和谐关系.结论使用Abbe唇瓣重建缺损的上唇唇珠及人中后,上唇形态接近自然。