Secondary unilateral cleft lip repair: combining rotation-advancement principles with a cross-lip muscle-vermilion flap.

Any lip without a complete philtral complex looks unnatural. This important anatomical entity can be recovered in many lips primarily closed with straight-line or Mirault-Blair-Brown-McDowell procedure. In these patients, combining a rotation-advancement upper lip revision with tubercle reconstruction using a cross-lip vermilion-orbicularis oris muscle flap results in a rotation-advancement scar ideally located in the skin of the upper lip and no scar in the skin of the lower lip. The tubercle is reconstructed as a unit from lower lip vermilion and muscle. The scar in the lower lip is restricted to the vermillion and therefore becomes extremely subtle and difficult to detect. The many scars resulting from a standard Abbe flap are avoided. Even patients with lip deformities considered too mild for a standard Abbe flap no longer need be denied lip revision when the cupid's bow is deficient.