BIPEDICLED AXIAL CROSS-LIP FLAP FOR CORRECTION OF MAJOR VERMILION DEFICIENCY AFTER CLEFT-LIP REPAIR

Vermilion irregularities are common secondary deformities after cleft lip repair. Particularly severe in bilateral clefts, vermilion deficie ncy attracts considerable attention and detracts from an otherwise exc ellent lip repair. Minor and moderate vermilion deficits can be correc ted with upper lip advancement, rotation flaps, tongue flaps, or graft s. Major defects defy correction with local flaps, because of an absol ute shortage of upper-lip tissue. A technique is described for correct ion of large absolute tissue deficits of the upper-lip vermilion using a bipedicled lower to upper cross-lip visor flap. A lower lip wet ver milion/mucosal flap is based bilaterally near the commissures on the c oronary arteries and transferred to a releasing incision at the wet/dr y vermilion border of the upper lip. The commissural pedicles are divi ded and inset at a second stage 10 days later to complete the transfer . The procedure provides ample bulk and lining for major upper-lip ver milion augmentation and tubercle reconstruction without disturbing the obicularis oris muscular oral sphincter. In addition it balances the lips and allows for feeding. The technique is illustrated in two patie nts with major upper-lip vermilion defects after repair of bilateral c left lips.