The Vermilionectomy and the Subsequent Lower Lip Reconstruction Were Introduced by Victor von Bruns and not by von Langenbeck or von Esmarch as Reported Previously

Abstract

Vermilionectomy is an established procedure for the management of precancerous lesions of the lip and is often performed simultaneously with a lower lip resection for the treatment of a malignancy. The literature suggests that Dieffenbach or von Langenbeck or von Esmarch was the first to introduce this procedure. A systematic review of the German literature from the 19th century revealed that it was von Bruns who performed the vermilionectomy for the management of lip malignancies for the first time.

Fig. 1.

A and B, “New technique for lip plasty through delivering and stretching of the vermilion” by von Langenbeck, translated from German (“Neues Verfahren zur Chiloplastik durch Ablösung und Verziehung des Lippensaums”). Drawing was published by von Esmarch and Kowalzig (1892). The supplementary transpositional flap from the chin was not mentioned in the original report by von Langenbeck [2 drawings taken from the original (4 × 3.5 cm each) in Esmarch and Kowalzig].

Fig. 2.

Vermilionectomy as described by Victor von Bruns from the “Chirurgischer Atlas” from 1857. Legends translated from German: “Curved excision” (“Bogenschnitt”); (A), “lip mucosal lining after `Bogenschnitt’ using a continuous suture” (B), “Lateral view of the lip after `Bogenschnitt’ to explain the mucosal lining of the lip (three sections” (C), the wedge excision of the red lip (C, first section) is explained in von Bruns’s Handbuch der praktischen Chirurgie (1859) as a further description of the vermilionectomy by Klose and Paul; (D) “Lip mucosal lining after `Bogenschnitt’ using single stitches in the left lip side and using Serre-fines in the right lip side”. [4 drawings taken from the original, plate XII/division II (48.5cm x 33.3 cm) in von Bruns, 1857]. The plate includes 45 drawings, each drawing sized 6cm x 4.5 cm). Reprinted with permission from Mohr Siebeck, Tuebingen, Germany.