Ways To Correct Upper Lip Defects

Larger defects in this area are repaired with an inferiorly based bilobed flap from the cheek. The first lobe of the flap should cover the nasal floor and upper lip, and the ala should be correctly positioned without tension in the angle between the first and second lobes (Fig. 6.16b). A larger defect in the upper lip can be repaired with a full-thickness sliding flap (Fig. 6.17) or advancement flap (Fig. 6.18). In the latter case a crescent-shaped skin excision is made in the alar groove above the upper lip defect, the cheek skin is mobilized, and the flap is advanced into the defect (Fig. 6.18a,b).

For larger defects in the upper lip area, the incision can be extended along the orbital margin and down past the angle of the mouth to create a kind of U-flap (Fig. 6.19a) for covering the defect (Weerda and Härle 1981; Weerda and Siegert 1990; Fig. 6.19b; see also Imre cheek rotation in Fig. 5.25 and Imre-Esser cheek advancement in Figs. 8.2 and 8.4).

Bilobed Flap Images

Fig. 6.13 Scar contracture causing lateral distortion of the upper lip.

a The scar is excised. A small flap is mobilized, and a Z-plasty is performed (see Figs. 2.16 and 6.11). b The completed repair.

Fig. 6.13 Scar contracture causing lateral distortion of the upper lip.

a The scar is excised. A small flap is mobilized, and a Z-plasty is performed (see Figs. 2.16 and 6.11). b The completed repair.

Imre Flaps

Fig. 6.14 Scar contracture with distortion of the commissure.

a The scar is excised, and a triangular-shaped flap with a lateral base is outlined in the upper lip. b The flap is transposed and inset, raising the commissure to a normal level.

Fig. 6.14 Scar contracture with distortion of the commissure.

a The scar is excised, and a triangular-shaped flap with a lateral base is outlined in the upper lip. b The flap is transposed and inset, raising the commissure to a normal level.

Bilobed Flap Nose

Fig. 6.15a, b Various flaps for repairing a defect in the nasal vestibule or upper lip.

c A large, inferiorly based nasolabial flap can be used to repair a defect in the nasal vestibule. A small flap covers the defect in the columella.

Fig. 6.15a, b Various flaps for repairing a defect in the nasal vestibule or upper lip.

c A large, inferiorly based nasolabial flap can be used to repair a defect in the nasal vestibule. A small flap covers the defect in the columella.

Upper Lip Reconstruction Flap

Fig. 6.16 Inferiorly based bilobed flap for repairing a defect in the upper lip and nasal vestibule

(after Weerda and Härle 1981). a Outline of the flap. b The flap is rotated into place, and all defects are closed. The ala is located between lobes L1 and L2.

Fig. 6.16 Inferiorly based bilobed flap for repairing a defect in the upper lip and nasal vestibule

(after Weerda and Härle 1981). a Outline of the flap. b The flap is rotated into place, and all defects are closed. The ala is located between lobes L1 and L2.

Littler Neurovascular Island Flap

Fig. 6.17 Neurovascular island flap from the lower cheek (after Weerda 1980d).

a The three-layered flap is advanced on a neurovascular pedicle (G = blood vessels plus a branch of the facial nerve). b The completed repair (see Fig. 6.29).

Cheek Advancement FlapMedial Cheek Advancement FlapCrescent Flap NasalLobe Flap Repair

Fig. 6.18 Burow's laterally based cheek advancement.

a For a defect in the upper lip, a crescent-shaped skin excision is made in the alar groove. b The cheek flap is advanced and all defects are closed.

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