Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka City University, Asahi 1-4-3, Abeno, Osaka 545-8585, Japan.
Journal of Plastic Reconstructive & Aesthetic Surgery (Impact Factor: 1.47). 01/2009; 63(1):22-7. DOI: 10.1016/j.bjps.2008.08.027
Source: PubMed

ABSTRACT The treatment of whistling deformity in patients with cleft lip remains controversial. Previous reconstruction methods of whistling deformity have been limited in volume due to the necessity for primary closure of the donor site. This article presents a new method for secondary reconstruction of the vermilion deformity in patients with cleft lip. Our method is very simple and advantageous, in that primary closure after correction is not required. A rectangular mucosal flap is designed at the wet mucosal aspect of the upper lip. Inferiorly, this flap is based at the junction of the vermilion and mucosa, while the upper incision line should be at the buccal sulcus. This rectangular flap is advanced sagittally, and a labial thickness is reconstructed. Artificial dermis is grafted to the mucosal defect after flap advancement and mucosa regenerates secondarily. We applied this technique to secondary reconstruction in 32 patients with cleft lip between January 2001 and January 2005. Major complications (necrosis of mucosal flap and recurrence of whistling deformity) did not occur in any of the patients. Four patients required minor operations to reduce the volume. CONCLUSIONS: This rectangular mucosal flap with artificial dermis offers many advantages, including easy technique and minimal sacrifices. The combination of mucosal flap and artificial dermis prevents postoperative scar contracture and reduces the limitations of using the available volume of flap. We believe that this procedure is versatile and reliable not only for whistling deformity in cleft lip patients, but also for tissue defects of the lip resulting from other causes.

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    ABSTRACT: BACKGROUND: Various techniques have been described for the correction of whistle deformity, but no single technique can be used for all types of whistle deformities because the cause of deformity and tissues available for its correction may be different. METHOD: Forty-seven cases of whistle deformity were divided in to 5 groups depending on its cause (deficient tissue) and the tissues available for its correction. Various techniques available for the correction of whistle deformity were analyzed. Techniques available for that particular group were short listed, and the appropriate technique was selected for correction of whistle deformity of the patient belonging to that particular group. RESULT: Of the 47 patients, 3 required reoperation. CONCLUSIONS: The proposed classification of whistle deformity and, accordingly, an algorithm for its management helps the operating surgeon to select the appropriate technique from a wide list of options available for correcting whistle deformity.
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