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.