25.  How do you reconstruct missing vermillion?

Answer:
An arterialized myocutaneous flap of the remaining vermillion can be advanced to close a defect based on the labial artery. This can be done in a unipedicle or a bipedicle manner.  Another method is an orbicularis myomucosal flap advanced as a V-Y plasty. A bipedicled musculomucosal flap can be advanced anteriorly to repair vermillion defects. Lateral buccal musculomucosal flaps can be transposed.  The next choice of donor tissue is the tongue but less than ideal because of color mismatch. Full-thickness grafts of palatal mucosa can also be used but color match is poor. Also grafts of labia minora can be used. Finally radial forearm free flap with tattooing can be used in reconsructing missing vermillion.
 

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