Managing lip large papilloma extirpation defect by arterialized advancement vermilion flap


  • Rahul Sahai Department of Plastic Surgery, S. N. Medical College, Agra, U. P., India
  • Sudhir Singh Department of Plastic Surgery, Getwell Hospital, Varanasi, U. P., India



Vermilion arterialized advancement flap, Lip defect, Papilloma


The close resemblance of squamous papilloma with verrucous carcinoma and the chief etiological factor associated with its development, the human papillomavirus (HPV) raises a doubt about its close association with malignancy. The best way to treat HPV growths is surgical removal and assessment of lesion by histopathology. The defect needs reconstruction with full function and aesthetic outlook. Thirty-seven years old young man with history of tobacco chewing developed slow growing papilloma in upper lip in one year. It was excised fully and the defect was repaired by arterialized lip vermilion mucosal flap based on slightly tortuous labial vessel and so the flap could be elastically stretched even up to fifty percent of lip length and applied successfully. Same patient developed papilloma in lower lip as a separate primary after two years of nonrecurrence of previous operated upper lip papilloma. Lower lip lesion was excised similarly and repaired with same type of vermilion mucosal advancement flap from adjacent part of lower lip defect created. The post-operative period was uneventful and after three years of last operation there is no recurrence in either lip. Vermilion flap which is based on labial artery containing composite tissue comprising of mucosa and portion of orbicularis muscle mainly has been utilized to reconstruct the post excision papilloma lip defect with excellent functional and aesthetic results. There was no microstomia. It is single stage not involving donor site like tongue or cheek mucosa and is good upto half of lower lip defects.

Author Biographies

Rahul Sahai, Department of Plastic Surgery, S. N. Medical College, Agra, U. P., India

plastic surgery, ex HOD and Professor at SN Medical College.

Sudhir Singh, Department of Plastic Surgery, Getwell Hospital, Varanasi, U. P., India

Plastic surgery Sr. Consultant and Hon. IMA Professor


Terai M, Hashimoto K, Yoda K, Sata T. High prevalence of human papillomaviruses in the normal oral cavity of adults. Oral Microbiol Immunol. 1999;14:201-5.

Varnai AD, Bollmann M, Bankfalvi A, Kovacs K, Heller H, Schmitt C, et al. The prevalence and distribution of human papillomavirus genotypes in oral epithelial hyperplasia: Proposal of a concept. J Oral Pathol Med. 2009;38:181-7.

Sabeena S, Pallade SR, Kamath N, Mathew M, Arunkumar G. Papilloma of lip associated with human papilloma viruses-32 infection in a child. Indian J Med Microbiol. 2016;34(1):97-9.

Bouda M, Gorgoulis VG, Kastrinakis NG, Giannoudis A, Tsoli E, Afentaki D, et al. High risk HPV types are frequently detected in potentially malignant and malignant oral lesions, but not in normal oral mucosa. Mod Pathol. 2000;13:644-53.

Mazzola RF, Lupo G. Evolving concepts in lip reconstruction. Clin Plast Surg. 1984;11:583-617.

Walker JC, Sawhney OP. Free composite lip grafts. Plast Reconstr Surg. 1972;50:142-6.

Jabaley ME, Orcutt TW, Clement RL. Applications of Karapandzic principle of lip reconstruction after excision of lip cancer. Am J Surg. 1976;132:529-32.

Johanson B, Aspelund E, Breine U, Holmstrom H. Surgical treatment of nontraumatic lower lip lesions with special reference to the step technique: a follow-up on 149 patients. Scand J Plast Reconstr Surg. 1974;8:232-40.

Owens N. Simplified method of rotating skin and mucous membrane flaps for complete reconstruction of the lower lip. Surgery. 1944;15:196-200.

Manafi A, Moghadam MA, Mansouri M, Bateni H, Arshad M. Repair of Large Lip Vermilion defects with Mutual Cross Lip Musculomucosal Flaps. Word J Plast Surg. 2012;1(1):3-10.

Kuttenberger JJ, Hardt N. Results of a modified staircase technique for reconstruction of the lower lip. J Craniomaxillofac Surg. 1997;25:239-44.

Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974;27:93-7.

Kawamoto HK. Correction of major defects of the vermilion with a cross-lip vermilion flap. Plast Reconstr Surg. 1979;64:315-8.

Estlander J. A method of reconstructing loss of substance in one lip from the other lip. Plast Reconstr Surg. 1968;42:360-4.

Neligan PC. Strategies in lip reconstruction. Clin Plast Surg. 2009;36:477-85.

Zarem HA, Greer DM. Tongue flap for reconstruction of the lips after electrical burns. Plast Reconstr Surg. 1974;53:310-2.

Manstein CH. Vermilionectomy and mucosal advancement. Plast Reconstr Surg. 1997;100:1363.

Goldstein MH. A tissue expanding vermilion myocutaneous flap for lip repair. Plast Reconstr Surg. 1984;73:768.

Goldstein MH. The elastic flap for lip repair. Plast Reconstr Surg. 1990;85:446-52.

Abbe R. A new plastic operation for the relief of deformity due to double harelip. Med Rec. 18981;53:477.

Ethunandan M, Macpherson DW, Santhanam V. Karapandzic flap for reconstruction of lip defects. J Oral Maxillofac Surg. 2007;65:2512-7.

Westreich R, Meisner J, Reino A, Lawson W. The use of combined Bernard-Webster and Karapandzic flaps for subtotal lower lip reconstruction. Plast Reconstr Surg. 2008;121:340-1.

Constantinidis J, Federspil P, Iro H. Functional and aesthetic objectives in the reconstruction of lip defects. Facial Plast Surg. 1999;15:337-49.






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