title: Aesthetic reconstruction of the upper lip with novel split musculomucosal-pedicle cross-lip flap.
abstract: BACKGROUND
  The upper lip can be divided into aesthetic subunits. Accordingly, we classified the upper lip defect into 3 categories: medial subunit defect, lateral subunit defect, and cross-subunit defect. The defect should be repaired aesthetically. We developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers. The flap was more flexible for aesthetic reconstruction of the upper lip, even the fine anatomic structures.
  
  
  METHODS
  For three and a half years, a total of 59 patients were used with this new technique, including those with secondary deformities from bilateral cleft lip, postinjury upper lip defects, and posthemangioma treatment defects. The inclusion criteria were that the defects of the upper lip were within 2.0 cm in adults and 1.5 cm in children generally. The split flap was elevated from the posterior portion of the orbicularis oris muscle after the inferior labial artery was divided. The flap was supplied by the vascular network derived mainly from the horizontal labiomental artery and/or the vertical labiomental artery.
  
  
  RESULTS
  All 59 cases of musculomucosal-pedicle flaps were viable. The upper lip was reconstructed according to the aesthetic subunits. In some cases, the fine anatomic structures were reconstructed, including the philtral column, the philtral dimple, curve of the Cupid's bow, and vermilion tubercle. The patients were all satisfied with their appearance.
  
  
  CONCLUSIONS
  This myocutaneous cross-lip flap with musculomucosal-pedicle is an effective method for aesthetic reconstruction of the upper lip. It can provide larger tissue with better flexibility and plasticity in clinical application.
authors.affiliation: From the Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Di
authors.initials: D
authors.lastname: Wu
authors.forename: Yongqian
authors.initials: Y
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Song
authors.forename: Haidong
authors.initials: H
authors.lastname: Li
authors.forename: Jiajun
authors.initials: J
authors.lastname: Wu
authors.forename: Wenjing
authors.initials: W
authors.lastname: Qu
authors.forename: Hengyuan
authors.initials: H
authors.lastname: Ma
authors.forename: Ningbei
authors.initials: N
authors.lastname: Yin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008046:Lip / Q000601:surgery*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation; D064827:Myocutaneous Flap; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D055815:Young Adult