Grunebaum Lisa Danielle, Smith Jesse E, Hoosien Gia E
Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA.
Facial Plast Surg. 2010 Dec;26(6):433-44. doi: 10.1055/s-0030-1267717. Epub 2010 Nov 17.
The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupid's bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.
口周损伤的处理是一个复杂的话题，必须考虑到嘴唇独特的解剖结构、组织学和功能，以便在损伤后最佳地恢复口腔的形态和功能。基本的重建原则包括对全层唇裂伤进行三层缝合。此外，需要特别注意对美学上复杂且重要的唇红缘、人中嵴和唇弓进行美观修复。眶下神经阻滞和颏神经阻滞可为唇裂伤修复提供唇部麻醉，而不会扭曲关键的美学标志。由于伤口被唾液污染，口周损伤通常需要预防性使用抗生素。口周烧伤的处理存在争议；然而，大多数唇部烧伤最初可采用保守治疗。口周烧伤二期愈合后可采用夹板固定、整形手术及其他重建方法。创伤后口周区域常见增生性瘢痕。唇部增生性瘢痕的主要治疗方法是硅酮弹性体片和病灶内注射类固醇。对于较大的口周缺损，有多种重建方法可供选择，从一期缝合、交叉唇瓣和局部组织转移，到游离组织转移，如桡侧前臂游离皮瓣、带神经股薄肌游离皮瓣、股前外侧游离皮瓣和骨皮游离皮瓣。
