2004 European Academy of Dermatology and Venereology

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CASE REPORT

JEADV

(2004)

18

, 487489
DOI: 10.1111/j.1468-3083.2004.00958.x

Blackwell Publishing, Ltd.

Sutures and Burrows triangles placed in the red vermilion in the
surgery of upper lip defects

A



Ascari-Raccagni,*



U



Baldari

Forl G. B. Morgagni L. Pierantoni General Hospital, Department of Dermatology,

Dermatological Surgery Unit, Piazza Solieri 1, 47100 Forl, Italy.

*

Corresponding author, Via Mascagni 44, 47100 Forl, Italy, tel. +039 0543 781162; E-mail: ascrac@libero.it

ABSTRACT

Background

In upper lip defects both the design of the ap and the position of the Burrows triangles may
be reversed so as to conceal the scars among skin wrinkles, folds and the mucosal lip to maximize the aes-
thetic outcome.

Objective

To report two cases of upper lip defects in which both scars and Burrows triangles were concealed
in the natural folds and the vermilion.

Methods

Both surgeries were performed under local anaesthesia.

Result

In both patients the scars were successfully concealed and the results aesthetically acceptable.

Conclusion

The technique described can be used to conceal scars in cases of upper lip defects with aesthet-
ically acceptable results.

Key words:

Burrows triangle, upper lip, red vermilion

Received: 9 July 2003, accepted 15 July 2003

Introduction

The upper lateral lip is a very peculiar anatomical site because
of its structure, a sandwich of an internal mucosal line, a
muscular complex and the skin; in constant movement it is
furrowed by wrinkles and outlined by the nasolabial fold above
and the mucocutaneous lip border below.
There are several methods to repair a wound in this area with
the advantage that most of the scar lines can be hidden around
the nasal ala and the vermilion, maintaining a high risk of dis-
placement of the lip and the nasolabial fold.

1

Dang and Green-
baum recently proposed removing a Burrows triangle from the
mucocutaneous lip in a modied Burrows wedge ap.

2

In the treatment of upper lip defects we planned to design
part of the incision on the mucocutaneous lip, the border of the
vermilion and the nasolabial fold, with the result that the scars
would be hidden by the natural folds and wrinkles (g. 1). In
planning to remove a Burrows triangle we converted the surgical
plan so that the triangle would be placed directly on the vermilion.
In the case of a Burrows triangle that was too large on the red
lip we converted a single triangle into various different triangles
with the base on the red lip border and the apex downwards

3

(g. 2).

Case reports

Case 1

A 65-year-old man was referred to our hospital for an ulcerated
nodule on the upper lip. A biopsy of the lesion conrmed the
clinical suspicion of a basal cell carcinoma (BCC) (g. 3). After
having surgically removed the lesion under local anaesthesia, a
large round defect was present on the external left side of the
upper lip; the shape of the lesion was turned into a triangle.
To repair the loss of tissue we performed an AT ap, with the
apex of the A placed upside down, deep in the vermilion of the
fig. 1 (a) First step; (b) second step.
488

Ascari-Raccagni & Baldari

2004 European Academy of Dermatology and Venereology

JEADV

(2004)

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, 487489

upper lip, and the horizontal sides of the T on the nasolabial
fold. The edges of the wound were handled with great attention
and stitched with detached 5.0 synthetic absorbable thread
(Sal green) on the mucosal side and 5.0 nonabsorbable thread
(Surgilene) on the skin.
The nal outcome was very good with a thin scar on the
mucosa, an inconspicuous scar on the skin of the upper lip and
a concealed, linear scar on the nasolabial fold (g. 4).

Case 2

A 55-year-old woman with a large, nodular, ulcerated and biopsy
proven BCC on her right upper lip was admitted in our depart-
ment (g. 5). The lesion was removed under local anaesthesia
resulting in a large, round defect that needed to be corrected.
fig. 2 (a) First step; (b) second step.
fig. 3 Case 1: before surgery.
fig. 4 Case 1: about 1 month after surgery.
fig. 5 Case 2: before surgery.
Burrows triangles in upper lip defects

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2004 European Academy of Dermatology and Venereology

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(2004)

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, 487489

We reshaped the lesion in a triangle with the horizontal side
on the border of the vermilion and the apex on the nasolabial
fold. Two symmetrical Burrows triangles were designed upside
down on the vermilion, along the main triangle horizontal side.
The closure of the defects was performed with 5.0 absorbable
stitches on the lip border and 5.0 nylon stitches on the upper lip
skin.
The procedure resulted in two inconspicuous scars on the
mucosal lip and a thin, long scar on the upper lip; a slight asym-
metry slowly improved and resolved soon after surgery (g. 6).

Discussion

Projecting how to ablate and correct a large defect on the upper
lip, we generally try not to intervene on the red vermilion,
maintaining the normal relations of these noble structures and
avoiding the asymmetry of the two sides. In a few cases,
however, a portion of the red vermilion can be removed in the
form of a Burrows triangle, so that the resulting scars remain
almost unnoticed on the mucosa. In some other cases the
Burrows triangles can be part of a complex ap resulting from
incisions on the borders of the vermilion or the nasolabial folds,
with scars mimicked in the natural folds. The length of the two
sides of the lips are slightly different immediately after surgery
but a spontaneous resolution of the asymmetry occurs in a few
months time. In short, the possibility to place scars on the
mucosal surface, the border of the lip or the nasolabial fold
enhances the chance to obtain aesthetically acceptable results in
the reconstructive surgery of the upper lip.

References

1 Tromovitch TA, Stegman SJ, Glogau RG.

Flaps and Grafts in
Dermatologic Surgery

. Year Book Medical Publishers, Chicago, 1989.
2 Dang M, Greenbaum SS. Modied Burrows wedge ap for upper
lateral lip defects.

Dermatol Surg

2000;

26

: 497498.
3 Gormley DE. A brief analysis of the Burrows wedgetriangle
principle.

J Dermatol Surg Oncol

1985;

11

: 121123.
fig. 6 Case 2: about 2 months after surgery.