Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips

The treatment of whistling deformity in patients with cleft lip remains controversial. Previous reconstruction methods of whistling deformity have been limited in volume due to the necessity for primary closure of the donor site. This article presents a new method for secondary reconstruction of the vermilion deformity in patients with cleft lip. Our method is very simple and advantageous, in that primary closure after correction is not required. A rectangular mucosal flap is designed at the wet mucosal aspect of the upper lip. Inferiorly, this flap is based at the junction of the vermilion and mucosa, while the upper incision line should be at the buccal sulcus. This rectangular flap is advanced sagittally, and a labial thickness is reconstructed. Artificial dermis is grafted to the mucosal defect after flap advancement and mucosa regenerates secondarily. We applied this technique to secondary reconstruction in 32 patients with cleft lip between January 2001 and January 2005. Major complications (necrosis of mucosal flap and recurrence of whistling deformity) did not occur in any of the patients. Four patients required minor operations to reduce the volume.

This rectangular mucosal flap with artificial dermis offers many advantages, including easy technique and minimal sacrifices. The combination of mucosal flap and artificial dermis prevents postoperative scar contracture and reduces the limitations of using the available volume of flap. We believe that this procedure is versatile and reliable not only for whistling deformity in cleft lip patients, but also for tissue defects of the lip resulting from other causes.