Advancement Musculocutaneous and Skin Flaps for Upper Lip Repair

Tissue replacement in the central part of the upper lip, the area defined laterally by a vertical line from the alar base to the free margin of the lip, is described. The flaps used are based on the principle of lip advancement by perialar crescentic excision (1, 2, 3).

INDICATIONS

Even small skin lesions in the central upper lip region may be difficult to treat by simple elliptical excision without disturbing the anatomic relationship between lip margin, alar base, and philtral ridge. Vertical ellipse excision cannot be done if the lesion is adjacent to the alar base. If the lesion lies between the alar base and the lip margin, an elliptical excision will produce vertical lengthening of the lip when it is sutured. The lengthening is caused by the approximation of the curved edges, making a straight line that is longer than the axis of the ellipse.

Repair of defects larger than half the central upper lip with this method using bilateral flaps is not recommended because it results in a significant discrepancy in length between upper and lower lips. The perialar flap can be used to cover any larger defect in the columella, the nostril floor, or both.

OPERATIVE TECHNIQUE

For smaller defects, lengthening of the lip may be avoided by using a small advancement flap with perialar crescentic excision (Fig. 163.1). It may be considered an elliptical excision, with its upper part shifted laterally to avoid the nostril.

FIGURE 163.1 A-C: Skin lesion of the upper lip adjacent to the nostril. V excision and perialar crescent. Closure after undermining of the lateral flap.

Only gold members can continue reading. Log In or Register to continue