Yildirim Serkan, Gideroğlu Kaan, Aydogdu Eser, Avci Gülden, Akan Mithat, Aköz Tayfun
Department of Plastic and Reconstructive Surgery, Kartal Dr. Lütfü Kirdar Education and Research Hospital, Istanbul, Turkey.
Plast Reconstr Surg. 2006 May;117(6):2033-41. doi: 10.1097/01.prs.0000210663.59939.02.
Major defects of the lower lip are challenging to the reconstructive surgeon. The major goals in treating total lower lip defects are reconstruction of the external skin and mucosal lining and maintenance of oral competence and sphincter function. The authors describe reconstruction of total lower lip and larger full-thickness defects including the cheek and commissure by means of a composite anterolateral thigh-fascia lata free flap.
The flap was harvested with 5-cm fascial extensions at the superior and inferior margins. The flap was folded over the fascia lata to restore the intraoral lining and cover the external skin defect. Fascia lata extensions were divided longitudinally into two fascial strips at both margins of the flap. Two strips were tunneled through the orbicularis muscle in the upper lip and sutured to each other and to the orbicularis muscle. The remaining two strips were anchored to the zygomatic bone periosteum by permanent sutures. This procedure was used in 11 patients.
In all cases, disease was advanced squamosus cell carcinoma. The patients' ages ranged from 37 to 72 years. Nine patients had cancer of the lower lip and two patients had a buccal cancer involving the lip. The entire lower lip, bilateral modiolus, and part of the cheek were resected in all patients, and mandibulectomy was performed in three patients. Flap survival was 100 percent. One patient died 10 days after the operation because of cardiopulmonary arrest. At the end of the 1-year follow-up period, all patients had good oral continence at rest and had achieved sufficient oral competence when eating. Eight patients were able to resume a regular diet and two patients could eat a soft diet.
This flap is a good choice for reconstruction of the extensive head and neck defects. We think that anterolateral thigh-fascia lata composite flap has maximum reconstructive capacity and minimal donor-site morbidity. This flap has many advantages over the radial forearm flap and should replace to the composite radial forearm palmaris longus tendon flap when total lower lip reconstruction is concerned.
下唇的大面积缺损对重建外科医生来说是一项挑战。治疗全下唇缺损的主要目标是重建外部皮肤和黏膜内衬，并维持口腔功能和括约肌功能。作者描述了通过股前外侧阔筋膜游离复合组织瓣重建全下唇及包括颊部和口角在内的较大全层缺损。
切取的组织瓣上下缘带有5 cm的筋膜延长部分。将组织瓣覆盖在阔筋膜上以修复口内黏膜内衬并覆盖外部皮肤缺损。阔筋膜延长部分在组织瓣的两侧边缘纵向分成两条筋膜带。两条筋膜带穿过上唇的口轮匝肌并相互缝合，同时与口轮匝肌缝合。其余两条筋膜带通过永久缝线固定于颧骨骨膜。11例患者采用了该手术方法。
所有病例均为进展期鳞状细胞癌。患者年龄在37至72岁之间。9例患者为下唇癌，2例患者为累及唇部的颊癌。所有患者均切除了整个下唇、双侧口角及部分颊部，3例患者行下颌骨切除术。组织瓣成活率为100%。1例患者术后10天因心肺骤停死亡。在1年随访期结束时，所有患者静息时口腔节制良好，进食时口腔功能足够。8例患者能够恢复正常饮食，2例患者能进软食。
该组织瓣是重建广泛头颈部缺损的理想选择。我们认为股前外侧阔筋膜复合组织瓣具有最大的重建能力且供区并发症最少。与桡侧前臂瓣相比，该组织瓣有许多优点，在全下唇重建时应取代桡侧前臂掌长肌腱复合组织瓣。
