Kim Joo-Hak, Ahn Chang Hwan, Kim Sunje, Lee Won Suk, Oh Sang-Ha
Department of Plastic and Reconstructive Surgery, School of Medicine, Chungnam National University, Daejeon, Korea.
Department of Emergency Medicine, Eulji University College of Medicine, Daejeon, Korea.
Arch Craniofac Surg. 2019 Apr;20(2):76-83. doi: 10.7181/acfs.2018.01984. Epub 2019 Apr 20.
The mental V-Y advancement flap method is useful for reconstruction of lower lip defect because of its many advantages. However, it is not easy to select the optimal reconstructive method for the vermilion defect that remains after application of the mental V-Y advancement flap. In choosing the representative surgical method for vermilion mucosal reconstruction including mucosal V-Y advancement flap, buccal mucosal flap, and buccal mucosal graft. We describe an efficient technique to large lower lip defects combining mental V-Y advancement flap and buccal mucosal graft.
This study included 16 patients who underwent reconstructive surgery for full-thickness and large defect (> half the entire width) of the lower lip from October 2006 to September 2017. The operation was conducted using mental V-Y advancement flap with various vermilion mucosal reconstruction methods considering the location of the defect and the amount of residual tissue of the lip coloboma after excision.
All patients underwent mental V-Y advancement flap. In vermilion mucosal reconstruction, five patients underwent mucosal V-Y advancement flap, three underwent buccal mucosal flap, and eight underwent buccal mucosal graft. There were good aesthetic and functional results in all patients who underwent buccal mucosal graft. However, two patients who underwent mucosal V-Y advancement flap complained of oral incompetence, and all patients who underwent buccal mucosal flap had oral commissure deformity.
Buccal mucosal graft combined with mental V-Y advancement flap can produce suitable functional and aesthetic outcomes in near total lower lip reconstruction in patient with large mucosal defect including vermilion portion.
颏部V-Y推进皮瓣法因其诸多优点，对下唇缺损的修复很有用。然而，为颏部V-Y推进皮瓣术后残留的唇红缺损选择最佳修复方法并非易事。在选择用于唇红黏膜重建的代表性手术方法时，包括黏膜V-Y推进皮瓣、颊黏膜瓣和颊黏膜移植。我们描述了一种将颏部V-Y推进皮瓣与颊黏膜移植相结合用于修复较大下唇缺损的有效技术。
本研究纳入了2006年10月至2017年9月期间因下唇全层及大面积缺损（>整个宽度的一半）而接受修复手术的16例患者。根据缺损部位及切除后唇裂残余组织量，采用颏部V-Y推进皮瓣联合多种唇红黏膜重建方法进行手术。
所有患者均接受了颏部V-Y推进皮瓣手术。在唇红黏膜重建方面，5例患者采用黏膜V-Y推进皮瓣，3例采用颊黏膜瓣，8例采用颊黏膜移植。所有接受颊黏膜移植的患者均获得了良好的美学和功能效果。然而，2例采用黏膜V-Y推进皮瓣的患者出现了口轮匝肌功能不全，所有采用颊黏膜瓣的患者均出现了口角畸形。
颊黏膜移植联合颏部V-Y推进皮瓣可为包括唇红部分在内的大面积黏膜缺损患者的下唇近全层重建带来合适的功能和美学效果。
