Roldán J Camilo, Schulte-Mattler Wilhelm
Department of Cranio-Maxillofacial Plastic Surgery, University of Regensburg, Regensburg, Germany; Division of Pediatric Facial Plastic Surgery and Craniofacial Anomalies, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany; Teaching Hospital of the University of Lübeck, Lübeck, Germany; Adult Plastic Reconstructive and Aesthetic Surgery of the Face at Anaesthesia Center Hamburg at UKE, Hamburg, Germany; Department of Neurology, University of Regensburg, Regensburg, Germany.
Plast Reconstr Surg Glob Open. 2016 Feb 10;4(2):e615. doi: 10.1097/GOX.0000000000000555. eCollection 2016 Feb.
In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson's step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster-related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided.
Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson's step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848.
Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study.
The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction.
在先前的一项研究中，与伯纳德·韦伯斯特相关技术（脸颊推进术）相比，单交叉唇瓣（阿贝瓣）联合约翰森阶梯技术修复超过2/3下唇缺损在美学和功能效果方面更具优势。在此，我们提出一种双交叉唇瓣（施泰因手术）用于修复下唇次全缺损，并对施泰因手术进行系统评价。
两名患者接受了旁正中双交叉唇瓣手术，保留了包含人中柱的美学亚单位，并联合约翰森阶梯技术。视频展示了美学和功能效果以及手术步骤。术后6个月和4年进行了肌电图研究。对1848年发表的关于施泰因手术的文献在PubMed和谷歌学术上进行了检索。
两名患者在切断交叉唇蒂后立即实现了唇部功能。在最初6个月里唇部逐渐增宽。未观察到小口畸形。肌电图显示术后6个月移植肌肉成功再支配。术后4年，肌电图结果得到巩固。自1975年以来，已发表7篇关于双交叉唇手术的文章：4篇用英文，1篇用法文，2篇用日文。这些文章均未报道任何补充性下唇推进术或任何肌电图研究。
与其他描述的下唇次全重建技术相比，采用2个交叉唇瓣和根据约翰森方法进行唇颊推进术的原理似乎能在功能和美学上取得更优的效果。
