A New Method for Reconstruction of Vermilion Deficiency in Cleft Lip Deformity: The Bi-Winged Myomucosa Switch Flap

Background: This study reviewed the method of using the bi-winged myomucosa switch flap for correction of secondary cleft lip deformity in patients with vermilion mucosa deficiency, lack of the central tubercle, and disproportionate lip projection, obviating the conventional Abbe flap when the prolabium has acceptable philtrum and Cupid's bow definition. Methods: The technique was applied to adult patients with secondary vermilion deficiency after primary bilateral cleft lip repair. The flap consisted of the transverse vermilion mucosa and the superior part of the orbicularis oris muscle from the lower lip. It was elevated, leaving a central cuff of muscle and mucosa tissue for blood supply, and tapered down bilaterally. The flap was transposed cephalically and inset to the deficient upper vermilion. Division of the pedicle was performed 2 weeks later. The preoperative and postoperative vermilion heights were measured, and the upper-to-lower vermilion ratios were calculated. Results: All consecutive patients tolerated the operations without perioperative or flap complications. The vermilion discrepancy was corrected in all cases. The vermilion height and projection were improved in the upper lip and the prominent lower lip was reduced. The average vermilion ratio was 0.38 before and improved to 1.00 after surgery, as compared with the norm of 0.96. Adequate lip function and mobility were maintained. All patients expressed satisfaction after surgery. Conclusion: The described technique of bi-winged myomucosa switch flap is an effective method for reconstruction of upper lip vermilion deficiency with excellent aesthetic outcome.