Department of Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock Street, Denver, CO 80204, USA.
J Plast Reconstr Aesthet Surg. 2012 Oct;65(10):1335-42. doi: 10.1016/j.bjps.2012.04.039. Epub 2012 May 29.
Reconstruction of total full-thickness lower lip defects combined with extensive composite mandibular defects particularly in the setting of close-range high-energy ballistic injury presents a formidable challenge for the reconstructive plastic surgeon. While the fibular flap has been widely accepted for its usefulness in the reconstruction of composite mandibular defects, to date, there is no definitive widely established method of total lower lip reconstruction. The article presents authors' approach using innervated gracilis muscle flap for total lower lip reconstruction in the setting of high-energy gunshot injuries to the face.
Three patients underwent composite mandibular defect reconstruction using fibular osteocutaneous flap and functional lower lip reconstruction using innervated gracilis muscle flap. Lip lining was reconstructed using the skin paddle of the fibular flap. The external surface of the gracilis muscle was skin-grafted. Facial artery myomucosal flap provided vermilion reconstruction in two patients.
All fibular (n=3) and gracilis flap transfers (n=3) were viable. An electromyographic study at 1 year postoperatively demonstrated successful re-innervation of the gracilis muscle. Starting at about 10 weeks postoperatively, patients exhibited voluntary lip movements and oral competence. In addition, all patients achieved near-normal speech, evidence of recovered protective sensitivity and satisfactory appearance. The mean follow-up was 16.1 months.
Our preliminary report in three patients demonstrated that innervated gracilis muscle transfer combined with fibular flap provides a successful reconstruction of extensive composite mandibular and total lower lip defects resulting from gunshot injuries to the face. Oral continence was achieved by combination of regained tonicity and voluntary movement of the gracilis muscle following re-innervation and assistance of the cheek muscles on the gracilis muscle. The described technique was reliable and the results were promising.
在近距离高能弹道伤的情况下，重建全层全下唇缺损并伴有广泛的复合下颌骨缺损，这对重建整形外科医生来说是一个巨大的挑战。尽管游离腓骨瓣因其在重建复合下颌骨缺损方面的有效性而被广泛接受，但迄今为止，尚无明确的全下唇重建的广泛确立方法。本文介绍了作者在高能面部枪伤情况下使用带神经的股薄肌瓣进行全下唇重建的方法。
3 名患者接受了复合下颌骨缺损重建（使用腓骨骨皮瓣）和功能性下嘴唇重建（使用带神经的股薄肌瓣）。使用腓骨瓣的皮瓣重建唇线。股薄肌的外表面植皮。2 名患者使用面动脉肌黏膜瓣提供唇红重建。
所有腓骨（n=3）和股薄肌瓣转移（n=3）均存活。术后 1 年的肌电图研究显示股薄肌成功再神经支配。大约术后 10 周，患者开始出现自主嘴唇运动和口腔功能。此外，所有患者均实现了接近正常的言语功能，恢复了保护性感觉，且外观令人满意。平均随访时间为 16.1 个月。
我们在 3 名患者中的初步报告表明，带神经的股薄肌转移联合腓骨瓣为面部枪伤导致的广泛复合下颌骨和全下唇缺损提供了成功的重建。通过再神经支配和颊肌对股薄肌的辅助作用，恢复股薄肌的紧张度和自愿运动，实现了口腔闭合。该技术可靠，结果有前景。
