Sahai Rahul, Singh Sudhir
Department of Plastic Surgery, SN Medical College, Agra, Uttar Pradesh, India.
Department of Plastic Surgery, Getwell Hospital, Varanasi, Uttar Pradesh, India.
Natl J Maxillofac Surg. 2022 Aug;13(Suppl 1):S113-S120. doi: 10.4103/njms.NJMS_162_20. Epub 2022 Aug 20.
In the present study of eight cases of traumatic lower lip defects, the reconstruction was achieved in a single stage by V-Y advancement island chin myocutaneous flap and labial mucosal advancement flap. There are many methods described for the reconstruction of small-to-large size of lower lip defects from straight-line closure of small defects to local flaps and free flaps for large defects. V-Y advanced chin flap has been reported previously also for the repair of lower lip defect with varying results. The vermilion reconstruction in others reported cases was done with the free mucosal grafts, V-Y labial mucosa advancement, or pedicled tongue flaps. Tongue flap is a two-stage procedure with esthetically unnatural look and an irregular surface of the vermilion. The free mucosa graft showed necrosis partial or complete resulting in irregular surface of vermilion and notching in the lip. V-Y labial mucosa advancement was done more for a small defect of the lip only. In the present series, we have repaired the vermilion of the lip by labial mucosal advancement flap, muscle by advancement of orbicularis oris from chin flap, and skin by V-Y advancement of island myocutaneous chin flap. Our results showed normal oral size with no evidence of microstoma or commissural distortion; oral competence was good with normal sphincteric function. The vermilion reconstructed had normal color and sensation. Lip seal was very good without notching defect in the vermilion. Drooling of saliva or speech defect was not noticed. The facial expressions and the look of the face were near normal. Hence, esthetically and functionally, the results were good without any irregularity or notching of the lip along with no incidence of drooling of saliva. We think that this technique may be considered as a procedure of choice for managing the moderate-to-large post traumatic defects of the lower lip. It is good esthetically and functionally besides being single stage for reconstructing moderate-to-large defects of the lower lip and is satisfying to the patient.
在本项针对8例创伤性下唇缺损病例的研究中,采用V-Y推进岛状颏部肌皮瓣和唇黏膜推进瓣一期完成重建。对于下唇缺损的修复,已描述了许多方法,从小缺损的直线缝合到局部皮瓣以及大缺损的游离皮瓣。此前也有报道采用V-Y推进颏部皮瓣修复下唇缺损,效果各异。在其他报道的病例中,唇红重建采用游离黏膜移植、V-Y唇黏膜推进或带蒂舌瓣。舌瓣是一种两阶段手术,外观不自然,唇红表面不规则。游离黏膜移植出现部分或完全坏死,导致唇红表面不规则和唇部切迹。V-Y唇黏膜推进主要用于修复较小的唇部缺损。在本系列研究中,我们通过唇黏膜推进瓣修复唇红,通过颏部皮瓣推进口轮匝肌修复肌肉,通过V-Y推进岛状颏部肌皮瓣修复皮肤。我们的结果显示口腔大小正常,无小口畸形或口角变形迹象;口腔功能良好,括约肌功能正常。重建的唇红颜色和感觉正常。唇闭合良好,唇红无切迹缺损。未发现流涎或言语缺陷。面部表情和面容接近正常。因此,在美学和功能方面,结果良好,唇部无任何不规则或切迹,也无流涎现象。我们认为该技术可被视为处理中至大型创伤后下唇缺损的首选方法。除了是修复中至大型下唇缺损的单阶段手术外,它在美学和功能上都很好,并且让患者满意。