Bilateral Vermilion Flaps for Lower Lip Repair

EDITORIAL COMMENT

Useful techniques rely on the dispensability of the vermilion portion of the lip. If the advancement is considerable, it will create a skin dog-ear inferiorly, which the author resects in the form of a triangle.

Bilateral vermilion flaps, a modification of a single arterialized vermilion flap used for small defects (1), can be used for median or central and rather lateral, larger defects of the lower lip (2).

INDICATIONS

These flaps are indicated for vermilion defects spanning two fifths to three fifths of the lower lip. Smaller defects also can be repaired, with better postoperative symmetrical balance than can be achieved by the unilateral flap (3). Advantages over other standard techniques include simplicity and safety, the requirement for little or no sacrifice of healthy tissue, and the promotion of rapid wound healing because the flaps are very well vascularized (2).

Bilateral vermilion flaps have been used for squamous cell carcinomas, malignant melanoma, and blue nevus. Where vermilion-only defects were present, the flaps were raised as myocutaneous tissue-expanding vermilion flaps, according to Goldstein (1). Where the defects extended to the white lip, a subcutaneous V-Y advancement flap of the lower lip was added to the bilateral vermilion flaps.

ANATOMY

The inferior labial artery runs close to the mucous membrane. There may be asymmetries or variations of lower-lip vermilion vascularization, including the equal distribution of the bilateral inferior labial arteries, the predominance of the artery on one side, the presence of the artery on only one side, or the artery presenting as the terminal branch of the sublabial artery (4, 5). In any case, an abundant vascular network is constantly recognized in the vermilion.

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