Kuwahara Masamitsu, Yurugi Satoshi, Mashiba Kumi, Ando Junji, Takeuchi Mika, Miyata Riyo, Harada Masayuki, Masuda Yasumitsu, Kanagawa Saori
Division of Plastic Surgery, Nara Medical University Hospital, Nara, Japan.
Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4110. doi: 10.1097/GOX.0000000000004110. eCollection 2022 Feb.
For large lower lip defects, a thin flap combined with a tendon is the standard reconstructive option. However, this method can result in flap ptosis, which occurred in two of our patients. To correct the ptosis, we transplanted costal cartilage into the reconstructed lower lips, which produced good or moderate results. We report our experience based on long-term follow-up. In case 1, reconstruction was performed with a latissimus dorsi myocutaneous flap. Within 10 years of the first cartilage transplant, two additional surgeries were required due to cartilage/screw breakage. These problems may have been triggered by the bulkiness of the flap and/or the angle at which the cartilage was anchored in place. There have not been any further problems for 3 years. In case 2, reconstruction was performed with a free anterolateral thigh flap. The skin around the flap had poor extensibility, and the patient had marked Class II occlusion. We grafted cartilage without fixing it to the mandible. However, temporary interference with the maxillary dentition was observed. In conclusion, costal cartilage grafts are effective against flap ptosis after free flap reconstruction of the lower lip in patients without Class II occlusion. To achieve long-term stability, the optimal angle and positioning of the cartilage and the extensibility of the skin must be thoroughly investigated before surgery, and a thick piece of cartilage must be firmly fixed in place.
对于较大的下唇缺损，薄皮瓣联合肌腱是标准的重建选择。然而，这种方法可能导致皮瓣下垂，我们的两名患者就出现了这种情况。为了纠正下垂，我们将肋软骨移植到重建的下唇中，取得了良好或中等的效果。我们基于长期随访报告我们的经验。病例1中，采用背阔肌肌皮瓣进行重建。在首次软骨移植后的10年内，由于软骨/螺钉断裂，需要进行另外两次手术。这些问题可能是由皮瓣的体积和/或软骨固定的角度引发的。3年来没有出现任何进一步的问题。病例2中，采用游离股前外侧皮瓣进行重建。皮瓣周围的皮肤延展性差，患者有明显的II类咬合。我们移植了软骨但未将其固定在下颌骨上。然而，观察到对上颌牙列有暂时的干扰。总之，对于没有II类咬合的患者，下唇游离皮瓣重建后，肋软骨移植对皮瓣下垂有效。为了实现长期稳定，术前必须彻底研究软骨的最佳角度和位置以及皮肤的延展性，并且必须将一块厚软骨牢固地固定到位。
