Bilateral Lateral Vermilion Border Transposition Flaps

EDITORIAL COMMENT

This is a good way to correct the whistle deformity and to provide for a symmetric lip with equal thickness throughout. It is especially suitable when V-Y advancement is not possible because of a shortage of midline tissue.

Bilateral lateral vermilion border transposition flaps can be used to correct the “whistling lip” deformity after cleft-lip repair. The procedure is a modification of a V-Y advancement of lateral vermilion flaps transposed 90 degrees (1, 2).

INDICATIONS

When patients with the whistle deformity have relatively ample lateral vermilion, these flaps can be used to reconstruct the absent median tubercle. The flaps can easily reconstruct a natural-appearing peaked and everted tubercle, decrease upper-lip tension, and deepen the labiogingival sulcus. They reduce the need for additional surgery, as in the creation of a cross-lip Abbé flap. The flaps can be used to repair a symmetric whistle deformity after bilateral cleft-lip repair and also to repair an asymmetric whistle deformity after unilateral cleft-lip repair.

FLAP DESIGN AND DIMENSIONS

The lateral vermilion flaps are marked inside the vermilion-mucosal junction (Fig. 178.1). These flaps tend to be wider than planned because the central-lip deficiency usually requires more tissue than expected. Lambdoidal markings in the midposterior prolabium should be located so as to decrease horizontal lip tension and to deepen the labiogingival sulcus after flap transposition. When used to correct an asymmetrical deformity, the width of the flaps and the location of the markings should be considered even more carefully.

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