Lip Fleur-De-Lis Flap
D. R. MILLARD JR.
This is a classic technique that attempted to replace the lost central portion of the lip. Such substantial deformities were created when the premaxilla or the columella was sacrificed as part of a cleft-lip repair, a sacrifice that fortunately is no longer made.
Through cancer ablation, radiation, or secondary congenital cleft lip deformities, a relative side-to-side tightness of a lip often occurs. There also may be deficiency in the free border vermilion. One lip may be tight and thin, with only a minimum of vermilion visible. The opposite lip may be loose, with voluminous vermilion in view (Fig. 160.1). In such circumstances, the lip fleur-de-lis flap has been found to be effective in two planes (1).
By extending the standard lip-switch flap with lateral mucosal flaps, it is possible to double its dimension of effectiveness. The standard lip-switch portion of the flap will reduce the relative slack of the donor lip while it releases the tightness of the opposite lip.
Simultaneously, the mucosal extensions on the lip-switch flap, taken out of the voluminous vermilion of one lip, are transported and inserted behind the thin free-border vermilion of the other lip. This has a balancing effect because the excessive vermilion is reduced while simultaneously bolstering the deficient vermilion of the opposite lip.
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