Bipedicled myomucosal flap for reconstruction of the lip after vermillionectomy

Solar keratosis is a well-documented premalignant condition caused by actinic radiation on the vermillion. The usual treatment method consists of surgical removal of the damaged area by means of sharp dissection, electrosurgery, chemical peeling, or recently CO2 laser beam. The denuded area is left to reepithelize (in cases of superficial removal) or is reconstructed by advancing mucosal flaps. Most of these methods assure a satisfactory clinical cure and a good function. The main disadvantage is esthetic because of a narrowing and flattening of the vermillion and loss of the pout. To overcome these side effects, we use a bipedicled vascularized myomucosal axial flap. Between 1982 and 1989, 19 patients were treated with this method. In this article we present the clinical aspects of solar keratosis, describe the surgical technique step-by-step, and evaluate the long-term outcome of this method.