A tissue-expanding vermilion myocutaneous flap for lip repair

An approach to lip reconstruction is described utilizing a myocutaneous vermilion flap based on the inferior labial artery. The inherent elasticity of the lip is used to great advantage by stretching the freed vermilion flap to bridge a loss of about one-half the lower lip. This vermilion flap may be worthy of consideration when reconstructing lip defects resulting from trauma (e.g., electric burns), tumor resections, and other congenital anomalies.     

Bilateral vermilion flaps for lower lip repair

A more natural reconstructive procedure of the lower lip using bilateral vermilion flaps was applied in five patients with excellent results. The vermilion defects were about two-fifths to three-fifths. In three patients, the vermilion defect was repaired using bilateral vermilion flaps alone. In the remaining two patients, a narrow horizontal lip defect was repaired by bilateral vermilion flaps and a subcutaneous V-Y advancement flap of the lower lip. A single vermilion flap or bilateral vermilion flaps are considered to be of great value for vermilion reconstruction because of the inherent elasticity and common anatomic unit. The postoperative scars are not remarkable at all. A long and narrow horizontal lip defect (perhaps within 1.5 cm downward from the vermilion border) may be effectively repaired by the combination of vermilion flap(s) and a V-Y advancement flap without sacrificing any additional healthy tissue.     

Contour correction of the vermilion of the upper lip by island flap of the lower lip

A method is shown to correct contour defects of the upper lip vermilion by an island of vermilion of the lower lip. A muscle bundle of the orbicularis oris is used to carry the island. It is tunneled around the commissure to the upper lip defect. Three cases are shown.     

Reconstruction of vermilion in unilateral and bilateral cleft lips

The white skin roll is a useful term to describe the cutaneo-vermilion border of the lip. The muco-vermilion border line parallels the white skin roll and is described as the red line. The lip vermilion should be constructed so that these lines are parallel and widest at the base of the philtral column. It is suggested that the triangular lateral lip vermilion flap be used in unilateral cleft lips. In bilateral cleft lips, a white skin roll vermilion-mucosal muscle flap is used for reconstruction of vermilion.     

The free tongue graft for correction of secondary deformities of the vermilion in patients with cleft lip

From January of 1985 to January of 1990, 31 patients with repaired cleft lip and secondary vermilion defects underwent 45 revisional procedures. A free tongue graft was utilized seven times in six patients (19 percent). Indications for its use were a V-shaped vermilion deficit or a "whistling" deformity associated with a sagittal vermilion deficiency and normal or insufficient lateral vermilion bulk. Of the seven free tongue grafts, none was lost. Three patients have required revisions, including repeat free tongue graft in one. Proper positioning of the graft along the free vermilion border has made color and texture match satisfactory. The free tongue graft is a simple and reliable means of transferring both vermilion bulk and surface mucosa. Introduction of the free tongue graft has eliminated the need for more cumbersome procedures, such as the Abbé flap or the tongue flap, in properly selected patients.     

Lip and vermilion reconstruction with the facial artery musculomucosal flap

The lips are a complex laminated structure. When lost through injury or disease, they present a complex reconstructive challenge. The facial artery musculomucosal (FAMM) flap is a composite flap with features similar to those of lip tissue. In this article, the anatomy, dissection, and clinical applications for the use of the FAMM flap in lip and vermilion reconstruction are discussed. A series of 16 FAMM flaps in 13 patients is presented. Seven patients had upper-lip reconstruction and six had lower-lip reconstruction. Superiorly based FAMM flaps were used in eight patients, and eight inferiorly based flaps were performed in five patients. Three patients had bilateral, inferiorly based flaps. In summary, the FAMM flap is a local flap that can be used for lip and vermilion reconstruction. Although not identical to the lip, it has many similar features, which make it an excellent option for lip reconstruction.     

Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity

Radical paring of the cleft edge during a primary cleft operation or repeated secondary surgeries can result in tightness of the upper lip. The degree of the resulting side-to-side tension can vary, from mild cases for which improvement is sought through realignment of the misplaced oral sphincter muscle in secondary revision, to severe cases for which the possibility of a lip switch flap must be considered. When the lip tightness accompanies more than three-quarters loss of the Cupid's bow, an Abbé flap is an alternative. However, the lip switch flap is far from ideal, in both artistic and functional perspectives, and should be avoided if at all possible in mild to moderate degrees of lip tightness. This study presents a method of correcting horizontal cleft upper lip tightness, especially of the vermilion. The method involves local transfer of an inferiorly based rectangular flap from the relatively redundant upper two-thirds to the lower one-third of the upper lip and vermilion. Primary indications for the technique include vermilion tightness with half to three-quarters loss of Cupid's bow. The method has the advantage of supplementing the horizontal lip dimension on the cleft side and restoring a natural Cupid's bow, thereby repositioning the shifted philtral column and adding fullness to the lower one-third of the upper lip. Incorporation of the upper lip scar in the rectangular flap removes ugly scars and spares the lower lip from surgical violation. The orbicularis sphincter function, as seen in facial animation, was well regained. Twenty unilateral and three bilateral cases with a maximal follow-up period of 4.5 years are presented.     

Free tongue composite graft for correction of a vermilion defect

A case report of hemangioma of the vermilion border treated with excision and free composite tongue graft is presented. A technique of lip reconstruction utilizing a composite tongue graft in one step has been described. It constitutes an improvement over the tongue pedicle flap technique, which has been hitherto used and requires two stages. The indications and limitations of the technique have been discussed.     

Comparative morphometric analysis of vermilion border epithelium and lip epidermis

A comparative morphometric study of lip epithelia in cattle, rats, and humans was undertaken using stereological techniques. Vermilion border and skin specimens of cattle, rats and humans were processed under standardized conditions for light microscopic observation. Stereological techniques were employed to obtain volumetric densities of each epithelial layer. The results obtained show that although the absolute volume of each epithelial stratum of the vermilion border and of the skin varies markedly in the different species studied, the relative volume of these strata in relation to the entire epithelium is similar in all epithelia.     

Three-dimensional lip morphometry in adults operated on for cleft lip and palate

Measurements were taken from 18 patients operated on for cleft lip and palate, aged 19 to 27 years, and 162 control subjects matched for sex, age, and ethnic group. Nine soft-tissue landmarks on the lips were digitized by a three-dimensional electromagnetic instrument. From the landmarks, several linear distances (mouth width, philtrum width, vermilion height of upper and lower lip, total vermilion height, total lip height), the interlabial angle, and some areas (vermilion of upper lip, vermilion of lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated. Patient and reference data were compared by t tests and Watson-Williams tests. In the men, significant differences (p < 0.05) were found in width of the philtrum, height and area of the vermilion part of the upper lip, and total vermilion height and area (all larger in male patients than in controls). In the women, significant differences were found in the height and area of the vermilion part of the upper lip (larger in female patients than in controls), and in the height and area of the vermilion part of the lower lip (smaller in patients than in controls). In both sexes, the interlabial angle was smaller than in the reference population. In conclusion, the upper lip of adult patients operated on for cleft lip and palate differed from that of healthy controls of the same age, sex, and ethnic group. Surgical correction of cleft lip and palate failed to provide a completely normal appearance. The analysis pointed out those parts of the lips and mouth (in particular, the vermilion part of the upper lip) that differed the most from the norm. The method may be used to indicate to the surgeon and patient where additional procedures might be performed to approximate the morphologic characteristics of a reference population.     

Unilateral gate flap for reconstruction of the lower lip

A unilateral gate-flap technique consisting of a nasolabial island flap is presented for the reconstruction of defects in the lower lip after excision of large, laterally located epidermoid tumors. The amount of healthy tissue resected is optimal. The reconstructed lower lip retains sensation and muscle function and is continent with a satisfying appearance. Temporary flap edema and a vermilion notch at the apex of the flap are both avoidable problems. This method may be used in selected patients with large advanced epidermoid cancers of the lower lip.     

Surgical treatment of the senile upper lip

Aesthetic changes in the aging upper lip constitute a troublesome problem for modern women. During the process of aging, the following alterations appear in the upper lip: (1) vertical wrinkles, (2) reduction in height of the vermilion border along with lengthening of the skin area of the lip, and (3) "disappearance" of the Cupid's bow. In 1993, Guerrissi and Sanchez described a surgical technique that allowed them to correct the effects of these senile changes in 19 patients. With the use of this surgical technique, a strip of skin on the vermilion border was deepithelialized. The remaining dermal flap was buried in the pocket, which was performed by undermining the superior third of the skin of the upper lip. The short-term results were satisfactory, although a slight reduction in height of the vermilion border and a decrease in the thickness of the lip were observed in five patients (26 percent) 4 years postoperatively. Beginning in 1994, the authors began using a new approach combining dermal flap reshaping with simultaneous lip augmentation using dermal-fat grafts, Gore-Tex (W. L. Gore and Associates, Flagstaff, Ariz.) or AlloDerm (LifeCell Corp., Branchburg, NJ.). No serious or definitive complications were observed. Scars on the vermilion border were not conspicuous. A peel was necessary at the same time for complete elimination of rhytids. With this method, both the patients and the surgeons were satisfied with the results.     

Bilateral cleft lip and nasal repair

SUMMARY: The bilateral cleft lip and nasal repair has remained a challenging endeavor. Techniques have evolved to address concerns over unsatisfactory features and stigmata of the surgery. The authors present an approach to this complex clinical problem that modifies traditional repairs described by Millard and Manchester. The senior author (H.S.B.) has developed this technique with over 25 years of surgical experience dealing with the bilateral cleft lip. This staged lip and nasal repair provides excellent nasal projection, lip function, and aesthetic outcomes. Lip repair is performed at 3 months of age. Columellar lengthening is performed at approximately 18 months of age. A key component of this repair focuses on reconstruction of the central tubercle. A triangular prolabial dry vermilion flap is augmented by lateral lip vermilion flaps that include the profundus muscle of the orbicularis oris. This minimizes lateral lip segment sacrifice and provides improved central vermilion fullness, which is often deficient in traditional repairs. The authors present the surgical technique and examples of their clinical results.     

Excision of precancerous lesions of the lip

A method of surgical treatment of precancerous lesions of the lip, by excision of the vermilion border and the advancement of the inner mucosa of the lip to cover the defect, satisfactorily removes the entire lesion and restores normal tissue to the lip surface.     

Lifting of the upper lip: personal technique

The authors illustrate a personal technique for lifting of the upper lip with augmentation of the lower lip. With this procedure, a shortening of the "prolabium," an increase of the vermilion, and a natural, nicer mouth are obtained, with the possibility of increasing the volume of the lower lip simultaneously. The operation is carried out as outpatient surgery using local anesthesia, with intravenous sedation if requested. Incisions are made bilaterally beginning at the alar fold of the nose; they then enter the nostrils and rise medially on the skin below the lower margin of the medial crura of the alar cartilage. In this way, the columella is safe, and there are no scars. Then, the two pieces of excess skin and a small, whole strip of orbicular muscle can be cut away, just under the nose. If the goal is to better extrude the vermilion, the skin as far as the Cupid's bow also has to be undermined; if the goal is to shorten the prolabium, a slightly wider amount of orbicular muscle can be removed. The muscle is suspended to the base of the nose with interrupted stitches (absorbable 4-0 suture), the subcutaneous tissue is sutured, and finally the skin is closed with a running suture. The removed muscle is a good graft for increasing the size of the lower lip.     

Evaluation of the database on mutant frequencies and DNA sequence alterations of vermilion mutations induced in germ cells of Drosophila shows the importance of a neutral mutation detection system

The vermilion gene in Drosophila has extensively been used for the molecular analysis of mutations induced by chemicals in germ cells in vivo. The gene is located on the X-chromosome and is a useful target for the study of mutagenesis since all types of mutations are generated. We have critically evaluated this system with respect to sensitivity for mutation induction and selectivity for different types of mutations, using a database of more than 600 vermilion mutants induced in postmeiotic male germ cells by 18 mutagens. From most of these mutants the mutation has been analysed. These data showed 336 base substitutions, 96 intra-locus DNA rearrangements and 78 multi-locus deletions (MLD). Mutants containing a MLD were either heterozygous sterile or homozygous and hemizygous lethal. The distribution of both basepair (bp) changes and intra-locus rearrangements over the coding region of the vermilion gene was uniform with no preferences concerning 5' or 3' regions, certain exons, splice sites, specific amino acid changes or nonsense mutations. Possible hotspots for base substitutions seem to be related to the type of DNA damage rather than to the vermilion system. Gene mutations other than bp changes were examined on sequence characteristics flanking the deletion breakpoints. Induction frequencies of vermilion mosaic mutants were, in general, higher than those of vermilion complete mutants, suggesting that persistent lesions are the main contributors to the molecular spectra. Comparison of induction frequencies of vermilion mutants and sex-linked recessive lethal (SLRL) mutants for the 18 mutagens showed that the sensitivity of the vermilion gene against a mutagenic insult is representative for genes located on the X-chromosome. The effect of nucleotide excision repair (NER) on the formation of SLRL mutants correlated with an increase of transversions in the vermilion spectra under NER deficient conditions. Furthermore, the clastogenic potency of the mutagens, i.e., the efficiency to induce chromosomal-losses vs. SLRL forward mutations, shows a positive correlation with the percentage of DNA deletions in the molecular spectra of vermilion mutants.     

Correction of macrocheilia due to hyperplasia of the labial salivary glands

A method for the correction of macrocheilia due to hyperplasia of labial salivary glands is presented. It can be carried out as an outpatient procedure under local anesthesia. A vermilion flap is elevated, providing good exposure for adequate excision and preventing lip distortion. In this method, bulkiness of the lip is reduced, preserving the normal general contour of the entire lip.     

Genome-wide markers reveal differentiation between and within the cryptic sister species,sunset and vermilion rockfish

The vermilion rockfish complex, which consists of the cryptic sister species vermilion and sunset rockfish, is one of the most valuable recreational fisheries on the U.S. West Coast. These species are currently managed as a single complex, and because of uncertainty surrounding the relative contribution of each species within existing data sources, the stock status of each species is not fully known. A reliable and cost-effective method is needed to disentangle these species that will allow for the development of abundance indices, life history profiles, and catch histories that may potentially support species-specific stock assessments. Using restriction-site associated DNA sequence (RADseq) markers we generated 10,003 polymorphic loci to characterize the vermilion rockfish complex. PCA and Bayesian clustering approaches based on these loci clearly distinguished between sunset and vermilion rockfishes and identified hybrid individuals. These loci included 203 highly differentiated (F_ST?≥?0.99) single nucleotide polymorphisms, which we consider candidates in the planned development of a diagnostic assay capable of distinguishing between these cryptic species. In addition to clearly delineating to species, subsets of the interspecific markers allowed for insight into intraspecific differentiation in both species. Population genetic analyses for sunset rockfish identified two weakly divergent genetic groups with similar levels of genetic diversity. Vermilion rockfish, however, were characterized by three distinct genetic groups with much stronger signals of differentiation and significantly different genetic diversities. Collectively, these data will contribute to well-informed, species-specific management strategies to protect this valuable species complex.

     

Early results of vermilion lip augmentation using acellular allogeneic dermis: an adjunct in facial rejuvenation

The definitive approach to lip augmentation has yet to be defined. Herein is described a technique using acellular allogeneic dermal grafts that is easy, effective, and reproducible. Our results over the past 2 years include 47 patients (94 grafts). Three grafts to the upper lip have exhibited significant resorption, which warranted further augmentation. Early in the series, one graft was malpositioned too superiorly along the vermilion-cutaneous border. There have been no cases of infection, hematoma, or graft exposure. The overall complication rate was 4 percent (4 of 94). Our early results by using acellular allogeneic dermal grafts for lip augmentation are encouraging. Further studies are under way to better objectively define long-term results.