Aesthetic reconstruction of the upper lip with novel split musculomucosal-pedicle cross-lip flap

The upper lip can be divided into aesthetic subunits. Accordingly, we classified the upper lip defect into 3 categories: medial subunit defect, lateral subunit defect, and cross-subunit defect. The defect should be repaired aesthetically. We developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers. The flap was more flexible for aesthetic reconstruction of the upper lip, even the fine anatomic structures.

For three and a half years, a total of 59 patients were used with this new technique, including those with secondary deformities from bilateral cleft lip, postinjury upper lip defects, and posthemangioma treatment defects. The inclusion criteria were that the defects of the upper lip were within 2.0 cm in adults and 1.5 cm in children generally. The split flap was elevated from the posterior portion of the orbicularis oris muscle after the inferior labial artery was divided. The flap was supplied by the vascular network derived mainly from the horizontal labiomental artery and/or the vertical labiomental artery.

All 59 cases of musculomucosal-pedicle flaps were viable. The upper lip was reconstructed according to the aesthetic subunits. In some cases, the fine anatomic structures were reconstructed, including the philtral column, the philtral dimple, curve of the Cupid's bow, and vermilion tubercle. The patients were all satisfied with their appearance.

This myocutaneous cross-lip flap with musculomucosal-pedicle is an effective method for aesthetic reconstruction of the upper lip. It can provide larger tissue with better flexibility and plasticity in clinical application.