The Abbe flap is commonly used for lip reconstruction. However, while it is effective for horizontal constrictions, it does not adequately release vertical constrictions.
The fleur-de-lis flap, described by Millard in 1964, is an Abbe flap with a horizontal vermillion flap, which can release not only horizontal but also vertical contracture of the upper lip. The original method is limited in size because the horizontal vermillion flap is elevated from the vermillion anterior to the inferior labial artery. In the present case, we elevated a horizontal mucosal flap from the oral vestibule posterior to the inferior labial artery to achieve large contracture release.
The patient was a 70-year-old male who had a complete upper lip defect after resection of an upper lip adenoid cystic carcinoma. His upper lip was reconstructed with a buccal advancement flap; however, salivation was observed due to upper lip entropion. Elevation of the mucosal flap was performed in two sessions. The mucosal flap of the lower lip opposite to the pedicle was transferred to the upper lip with the Abbe flap in the first operation. The mucosal flap on the pedicle side was elevated at the time of flap separation and implanted after the contracture was released in the same manner.
Postoperatively, the patient's salivation symptom was improved. We consider this flap to be one of the useful methods to release vertical contracture of the upper lip.
