The Vermilion Myomucosal Advancement Flap for Reconstructing Superficial Lip Defects

Abstract

Background: – Reconstruction of vermilion defects is challenging, requiring restoration of aesthetics, function, and sensation. The vermilion myomucosal advancement flap, which uses adjacent native tissue, is an ideal technique for this purpose. This study evaluates the outcomes of this flap for reconstructing full-thickness vermilion defects. Methods: – The authors retrospectively reviewed 17 patients who underwent vermilion reconstruction with myomucosal advancement flaps for defects involving <50% of the lip width. Outcomes were assessed at 12 months postoperatively. Aesthetic satisfaction and scar quality were evaluated by both patients (Visual Analog Scale, VAS) and independent surgeons (Patient and Observer Scar Assessment Scale, POSAS). Sensory recovery was measured with the Semmes-Weinstein Monofilament (SWM) test. Results: – The cohort included 17 patients (mean age 42.9 y) with defects averaging 1.9 cm in width. Excellent aesthetic outcomes were achieved, with high satisfaction scores from both patients (mean VAS 9.24) and observers (mean VAS 8.76). Scar scores were low, and a strong correlation was found between patient satisfaction and scar quality (r=0.87). Only one minor complication (dehiscence) was recorded. Sensory recovery in the flaps was excellent, with SWM scores approaching those of healthy tissue (2.97 versus 2.83). All oncologic margins were clear with no recurrence. Conclusion: – The vermilion myomucosal advancement flap is a safe, reliable, single-stage procedure for small to moderate vermilion defects, yielding superior aesthetic, functional, and sensory outcomes with minimal morbidity. A flap-to-defect length ratio of 2:1 is an effective guideline for surgical planning.