Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Reconstructive Surgery

Background:

• Cleft lip repair can lead to upper lip tightness and scarring, impacting aesthetics and function.
• Existing secondary revision techniques like lip switch flaps have limitations, especially for moderate tightness and Cupid's bow defects.
• Abbé flaps are considered for severe cases with significant Cupid's bow loss.

Observation:

• A novel technique involves transferring an inferiorly based rectangular flap from the upper lip to address horizontal tightness and vermilion defects.
• Primary indications include vermilion tightness with moderate to severe Cupid's bow loss (50-75%).
• The procedure aims to augment horizontal lip length, restore the Cupid's bow, and reposition the philtral column.

Findings:

• The rectangular flap technique successfully supplemented lip dimension and recreated a natural Cupid's bow.
• Scarring was improved by incorporating the upper lip scar into the flap.
• Orbicularis oris muscle function was well-preserved, as evidenced by facial animation.

Implications:

• This flap offers an alternative to less ideal lip switch or Abbé flaps for specific cleft lip deformities.
• It provides both functional and aesthetic improvements, particularly for vermilion tightness and Cupid's bow reconstruction.
• The technique avoids further surgical violation of the lower lip, preserving its integrity.