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Original Investigation
June 29, 2017

Complete Philtrum Reconstruction on the Partial-Thickness Cross-Lip Flap by Nasolabial Muscle Tension Line Group Reconstruction in the Same Stage of Flap Transfer

Author Affiliations
  • 1Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
JAMA Facial Plast Surg. Published online June 29, 2017. doi:10.1001/jamafacial.2017.0296
Key Points

Question  Can a philtrum be completely reconstructed on a partial-thickness cross-lip flap transfer using nasolabial muscle tension line group reconstruction?

Findings  A stable philtrum with philtral ridge and philtral dimple was reconstructed on flaps in 5 of 6 patients. The shape of the philtrum was natural according to the 3-dimensional scan measurement.

Meaning  A complete philtrum structure can be reconstructed by applying muscle tension on the flap.

Abstract

Importance  The blood supply pattern of the partial-thickness musculomucosal pedicle flaps is different from the traditional Abbe flap. The arterial blood supply and venous drainage are highly reliable during clinical practice.

Objective  To describe the reconstruction of the philtrum in the cross-lip flap transfer using nasolabial muscle tension line group reconstruction.

Design, Setting, and Participants  From January 1, 2014, through June 31, 2015, a total of 6 patients with upper lip defect were treated with philtrum reconstruction in the same stage of the split cross-lip flap transfer at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. These patients underwent reconstruction of the philtrum by nasolabial muscle tension line group reconstruction. The patients were compared with a randomly chosen group of 5 individuals without upper lip defects by measuring the 3-dimensional scans.

Interventions  In the patient group, the split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided. Then the partial-thickness flap was rotated 180° horizontally and inverted 180° upward to the upper lip defect. The philtrum was reconstructed using the nasolabial muscle tension line group reconstruction.

Main Outcomes and Measures  Three-dimensional scans were performed from the 2-month to 28-month revisits.

Results  A total of 11 individuals were included in the study: 6 in the patient group (mean [SD] age, 17.0 [4.8] years; 2 [33.3%] female and 4 [66.7%] male) and 5 in the control group (mean [SD] age, 15.2 [6.0] years; 2 [40.0%] female and 3 [60.0%] male). In the patient group, 5 of 6 musculomucosal pedicle flaps were viable. A stable philtrum with philtral ridge and philtral dimple was reconstructed on the 5 flaps. The shape of the philtrum was natural according to the 3-dimensional scan measurement. One flap partially necrosed, and the scar retraction was severe postoperatively.

Conclusions and Relevance  The blood supply of the partial-thickness cross-lip flap was from the small vascular network of the lower lip. It is reliable to reconstruct a philtrum in this stage of flap transfer. A complete philtrum structure can be reconstructed by applying muscle tension on the flap.

Level of Evidence  4.

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