Secondary reconstruction of asymmetric volume deficits of the lips: a transverse twist flap technique

The reconstructive surgeon, dealing with both congenital anomalies such as clefts, and post-surgical or post-traumatic defects, may, on occasion be faced with a situation where there is either a unilateral deficit or excess of lip volume, or an asymmetry with bilateral volume inequalities. The classic examples of this are the characteristic whistle notch deformities sometimes seen after cleft-lip repairs. This paper presents another useful solution to such problems. The method involves the transposition of a transversely-oriented flap of mucosa, elevated on a connective tissue/muscle pedicle, and twisted or rotated 180° from the contralateral side of the lip, to help fill the defect. The flap is asymmetrical, thus enabling transposition of more tissue into the primary defect than is lost from the donor site. The principal advantage is that in a lip in which there is already an overall paucity of tissue, nothing further is discarded, while at the same time, tissue is replaced where it is most needed. A secondary benefit is that with proper design, the lip can be shortened from side to side and therefore filled out in the antero-posterior dimension. Technical details of the method are explained and the versatility of the technique is illustrated.