J Korean Assoc Oral Maxillofac Surg.  2024 Aug;50(4):222-226. 10.5125/jkaoms.2024.50.4.222.

Reconstruction of an upper lip vermilion defect with a mucosal V-Y advancement flap: a case report

• Shim GJ
• Yoon HW
• Kim D
• Kwon TG

• KMID: 2559269
• DOI: http://doi.org/10.5125/jkaoms.2024.50.4.222

Abstract

The upper lip is a functionally and aesthetically important area of the face. Therefore, reconstruction of an upper lip defect needs sufficient consideration to ensure functional and aesthetic recovery. Several methods, such as wedge resection, rotation flaps, advancement flaps, and myomucosal advancement flaps, have been used to reconstruct vermilion defects. However, it is challenging to reconstruct a vermilion defect because of the possibility of residual asymmetry or scars and restrictions to normal lip movement after the reconstruction. We present the case of a 51-year-old female that had an upper lip vermilion defect caused by a dog bite. The lip defect was reconstructed using a mucosal V-Y advancement flap. This mucosal flap was based on the orbicularis oris muscle with a branch of the superior labial artery to ensure sufficient blood supply. Therefore, flap survival was excellent, and there was no constriction of the flaps. Moreover, the color and contour were matched to the adjacent lip tissue, and re-establishment of the white roll and adequate lip volume were achieved. This mucosal V-Y advancement flap technique represents a reliable method to repair mucosal defects without vascular compromise of the flap.

Keyword

Lip; Mouth mucosa; Myocutaneous flap; Reconstructive surgical procedures

Figure

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  Fig. 1 A. The lip wound was thoroughly debrided before reconstruction. B. Design of the mucosal V-Y advancement flap in the inner mucosal area. C. Completion of the mucosal V-Y advancement flap dissection based on the orbicularis oris muscle. An additional horizontal incision was made in the orbicularis oris muscle to facilitate flap mobilization. D. The shield-shaped flap was moved superiorly to approximate the superior flap margin to the vermilion border. E. The V-Y suture was placed between the inner mucosa and flap. F. After reconstruction of the upper lip defect, good color matching and volume were observed.

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  Fig. 2 Schematic illustration of the mucosal V-Y advancement flap. A-C. The mucosal incision was made at the inner lip mucosa. The mobilized mucosal flap was approximated to the vermilion-skin border. The inner vestibule was sutured in a Y-shaped manner. D, E. Cross section of the flap. The labial artery was included in the mucosal flap, and dissection proceeded.

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  Fig. 3 A. Clinical findings of the lip immediately after the surgery. B. One-month postoperative photograph. Excessive lip volume from the mobilized flap was revised after excision of the redundant lip tissue. C. Six-month postoperative view. D. One year after the reconstruction, both the volume and width of the flap were symmetrical and matched the original color.

Reference

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