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Fig. 1

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(A). View of the ulcerating painless lesion and two incisions line; one is extended along the anger lines of the cheek and the other is paranasal. (B). According to the pre- analysis for the possibility of the defect, the right commissure and right upper lateral and lower lip defects after lesion resection would belong to the infra-nasal medial plus ipsilateral commissure lip defect. Thus, at the circular outline of the lesion, two incisions were made extending along the Langer’s lines on the cheek and perinasal area, which passed and skirted from the circular base of the ala of the nose and were limited near philtrum. Then, an adjacent double-lobe flap compressing the infra-nasal upper lateral lip lobe (named A) and para-nasal lobe (named B) was raised. After gaining adequate mobilization (Figure 1.B), the combined transposition of lobe A and lobe B closed this defect. The nasolabial lobe closed the upper lateral lip lobe with half of the commissure part of the defect through transposition, and the infra-nasal lobe covered half of the commissure and the lower lip part. For matching the extension with combined transposition and easily accommodating the double transposition of two lobes, A and B, the common pedicle base of these lobes was elongated a little upward to the commissure of the upper and lower lips. In addition, lobes A and B were incised circularly in order to get the correct anatomical shape of the new commissure. The secondary defect or the donor site was closed primarily with advanced surrounding tissues.