title: New way to raise the V-Y advancement flap for reconstruction of the lower lip: bipedicled orbicularis oris musculocutaneous flap technique.
abstract: We describe a new way to raise the V-Y advancement flap, which is useful for reconstruction of the lower lip. Various other methods have been reported in the past, but it has been necessary to choose the most suitable method for each particular case. A V-Y advancement flap from the submandibular region is one of the useful techniques to reconstruct the lower lip, and it is suitable for a wide horizontal defect. However, the conventional V-Y flap is insufficiently mobile and the reconstructed vermilion is thin because of the limitation of the pedicle. In such a case, the reconstructed lip may sag or cause an embarrassing defect. We developed a new way to raise the flap to obviate these problems. We use the V-Y advancement flap from the inferior margin of the defect in a conventional way after excision of the tumour, and use a mucosal flap to reconstruct the vermilion border. The skin side of the V-Y flap is undermined, and the orbicularis oris muscles are preserved on both sides as pedicles. The flap is then raised as a bipedicled musculocutaneous flap, which has adequate movement. After the flap has been sutured, the superior margin of the flap is de-epithelialised, and used to create the volume of the vermilion border. Functionally and cosmetically good results were achieved.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan. urushi@cc.hirosaki-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Urushidate
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yokoi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Higuma
authors.forename: Makoto
authors.initials: M
authors.lastname: Mikami
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Makiko
authors.initials: M
authors.lastname: Saito
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Saito
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Yotsuyanagi
mesh_terms: D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004954:Esthetics; D005152:Facial Muscles / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D006801:Humans; D008048:Lip Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology