Use of Lower Vermilion Cross-Lip Flap for Correction of Whistle Deformity in Clinical Practice and Anatomic Study for the Secondary Cleft Lip Repair

Background: The lower vermilion cross-lip flap is usually indicated for large upper-lip vermilion defects. This article points out the importance of the donor site incision and reveals the significance of incorporation of inferior labial artery in this flap. Materials and Methods: The cadaveric study was designed to measure the vertical distance between the upper most parts of the inferior labial artery to vermilion surface in 22 fresh male cadavers. Tissue specimens were taken from the lower lip at the midline in the sagital plane. Moreover, the histologic sections were stained with hematoxylin-eosin, and the measurements were done under light microscope. Alternatively, the divided-pedicle group study consists of 6 patients with lower vermilion cross-lip flap, in which the pedicles were sent to the laboratory for histologic examination after pedicle division. Results: The distance between the inferior labial artery and the upper most part of the vermilion border was 2.42 +/- 1.67 mm. In 77.27% of cases, the artery was found in the submucosal layer. The histologic examination of the pedicles in 6 patients showed the presence of inferior labial artery, in hematoxylin-eosin staining, in the serial cross sections of 5 pedicles. Conclusions: Four-millimeter-deep incision of the lower lip's vermilion will embody the inferior labial artery in lower vermilion cross-lip flap in most of the cases. Moreover, the histologic study of the pedicles revealed that the incorporation of the inferior labial artery in flap pedicle will ensure flap perfusion.