Nguyen Dinh T, Oki Koichiro, Hyakusoku Hiko, Ogawa Rei
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan; Dr Nguyen is in private practice at Boston, MA.
Eplasty. 2011;11:e26. Epub 2011 May 13.
Upper lip defects less than one-fourth of total upper lip length are typically closed directly, but larger defects require reconstruction. Established techniques, such as the Abbe/Estlander flap, often require multiple procedures. This report discusses a single-step method, involving a skin-mucosa double opposing V-Y advancement flap, which was utilized to reconstruct the upper lip after basal cell carcinoma extirpation.
The patient is a 54-year-old woman who presented with a 2.5-cm basal cell carcinoma in the right upper lip. Two parallel V-Y flaps were designed, on "parallel" planes of the skin and mucosa, and were advanced following wedge resection of tumor and portion of the adjacent orbicularis oris muscle. Skin/mucosa flap edges were brought to create a new skin-vermilion border, which was then sutured onto existing skin-vermilion border edges.
The patient was evaluated 6 months after the operation, and examination showed well-healed flaps with excellent aesthetic and functional results. There was a thin, marginal scar, where reconstructed vermilion (medial) edge was sutured to native vermilion.
It was considered that this method could reconstruct anatomical features and function of the lip precisely. It seems that within certain limits (probably between one-fourth and one-third of total upper lip length), skin-mucosa double opposing V-Y advancement flaps appear to be the preferred method for upper lip reconstruction.
上唇缺损小于上唇总长度四分之一的情况通常可直接缝合，但较大的缺损则需要进行重建。已有的技术，如阿贝/埃斯特兰德皮瓣，往往需要多次手术。本报告讨论了一种单步方法，即采用皮肤-黏膜双反向V-Y推进皮瓣，用于基底细胞癌切除术后的上唇重建。
患者为一名54岁女性，右上唇有一个2.5厘米的基底细胞癌。在皮肤和黏膜的“平行”平面上设计了两个平行的V-Y皮瓣，在楔形切除肿瘤及部分相邻口轮匝肌后推进。将皮肤/黏膜皮瓣边缘拉拢形成新的皮肤-唇红缘，然后缝合到现有的皮肤-唇红缘边缘上。
术后6个月对患者进行评估，检查显示皮瓣愈合良好，美观和功能效果极佳。在重建的唇红（内侧）边缘与原唇红缝合处有一条细小的边缘瘢痕。
认为该方法能够精确重建唇部的解剖结构和功能。在一定限度内（可能在上唇总长度的四分之一至三分之一之间），皮肤-黏膜双反向V-Y推进皮瓣似乎是上唇重建的首选方法。
