Plastic Reconstructive and Aesthetic Surgery-Microsurgery, Hospital Tenon, Paris, Île-de-France, France.
Plastic and Reconstructive Surgery, Hôpital Armand-Trousseau, Paris, Île-de-France, France.
Microsurgery. 2021 May;41(4):366-369. doi: 10.1002/micr.30703. Epub 2021 Jan 4.
Reconstruction of upper lip defects can be challenging even for experienced surgeons. In order to restore both function and morphology, the use of quality soft tissue is essential. To this effect, the most common solution is the use of local flaps, or, in extreme situations, a free flap. However, a thin cutaneous upper lip defect may require a different approach. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. We present the case of a 41-year-old female with a 1 × 1.5 cm basal cell carcinoma of the right-side upper lip, initially treated with a full thickness skin graft. Due to poor aesthetic and functional result, a thin submental artery perforator (SMAP) flap reconstruction was performed. Flaps' dimensions were 6 cm long and 4 cm wide and it was based on a perforator arising from the submental artery. Dissection was conducted above the platysma muscle, and the SMAP flap was transferred into the defect through a subcutaneous tunnel created below the mandible and posterior to the anterior belly of digastric muscle. The pedicle length of 6.5 cm was adequate for a tension free inset of the flap. Postoperative course was uneventful and the patient was discharged after 2 days. The 4-month follow-up showed a satisfying functional and aesthetic outcome with a concealed donor site scar. This report points out the coverage potential of the thin SMAP flap, which can be successfully used for a harmonious reconstruction in both color and texture of the upper lip.
即使对于经验丰富的外科医生来说，上唇缺损的重建也具有挑战性。为了恢复功能和形态，必须使用优质的软组织。为此，最常见的解决方案是使用局部皮瓣，或者在极端情况下使用游离皮瓣。然而，对于较薄的上唇皮肤缺损，可能需要采用不同的方法。穿支皮瓣具有多功能性，可以使用相邻的类似组织高效地重建软组织缺损，提供“相似覆盖”的益处。我们报告了一例 41 岁女性右侧上唇 1×1.5cm 基底细胞癌的病例，最初采用全厚皮片移植治疗。由于美容和功能效果不佳，进行了薄型颏下动脉穿支（SMAP）皮瓣重建。皮瓣的尺寸为 6cm 长，4cm 宽，基于颏下动脉的穿支。在颈阔肌上方进行解剖，并通过在下颌骨下方和二腹肌前腹后面创建的皮下隧道将 SMAP 皮瓣转移到缺损处。6.5cm 的蒂长度足以使皮瓣无张力地嵌入。术后过程顺利，患者在 2 天后出院。4 个月的随访显示，功能和美容效果令人满意，供区瘢痕隐蔽。本报告指出了薄型 SMAP 皮瓣的覆盖潜力，可成功用于上唇的颜色和质地的和谐重建。
