以唇动脉为蒂的唇瓣修复中度和重度唇全层缺损

目的探讨中、重度全层唇缺损的修复方法.方法在缺损一侧或两侧(若缺损较大,一侧唇瓣不够用时)设计以唇动脉为蒂的唇瓣向缺损区推进转移修复全层唇缺损.若缺损较大,单纯用缺损两侧口唇组织仍不足以修复时,可将一侧唇瓣向外侧延伸绕过口角至另一侧上或下唇(根据缺损是在下唇或上唇),形成包括上下唇组织在内的大型唇瓣向缺损区推进修复缺损.若缺损为单纯的红唇缺损,唇瓣切口应沿唇弓设计.结果临床应用于67例,其中上唇38例,下唇29例.缺损最大水平宽度3.5 cm,最小1.6 cm.单纯红唇瓣20例,红白唇瓣47例.单侧唇瓣10例,双侧57例.所有唇瓣均全部存活,伤口Ⅰ期愈合,修复后的口唇丰满,外形满意.结论唇动脉血管恒定,唇瓣血供可靠,本法不仅能用于单纯红唇缺损的修复,还可广泛用于红、白唇同时缺损的修复,因是用同类组织修复,且组织量丰富,故术后能完全恢复口唇所特有的红、白唇结构及功能,是修复中、重度全层唇缺损的理想方法.

Repair of moderate or severe full lip defect with composite lip flap pedicled with lip arteary

Objective To explore a method for repairing moderate or severe full defect of lip. Methods One composite lip flap pedicled with lip artery was designed at one side of the defect. If the area of defect was too large, two flaps beside the defect should be designed, and one of two flaps could be extended to lower or upper lip at the angle of mouth to form the large composite lip flap which included the part of another lower or upper lip. The blood supply of this flap came from another side lower or upper lip artery, so it could not be necrotic. The flaps were cut along the design line and propelled to repair the defect. If one flap included the part of another lower or upper lip, the facial artery was ligated and cut at the branching point of upper and low lip artery, so as to increase the movement of the flap. First the oris orbicularis muscles were sutured, then the lip mucosa and skin were sutured separately. If the defect was located at vermilion, the flaps should be designed and cut along the vermilion boundary. Results This method was used in 67 cases, in which 38 cases were the upper lip defect and 29 cases were the lower lip defect. 20 cases were repaired by vermilion flaps and 47 cases by composite flaps which included vermilion and white lip. 10 cases were repaired by one flap and 57 cases by two flaps. The biggest width of the defect was 3.5 cm and the smallest was 1.2 cm. All the flaps survived. The repaired lip was plump and the postoperative appearance of the lip was satisfactory. Conclusions The lip artery is constant. The blood supply of the flap is reliable and anatomizing the flap is easy. The lip defect is repaired with the same tissue, so the lip's shape and functions can be recovered completely. This procedure can be widely used in repairing vermilion and white defect. It is an idea method for repairing moderate or severe full lip defect.