From the Department of Plastic, Reconstructive and Aesthetic Surgery Gaziosmanpaşa University Medical School, Tokat, Turkey.
Ann Plast Surg. 2024 Nov 1;93(5):589-596. doi: 10.1097/SAP.0000000000004113.
The lower lip is an important anatomical structure involved in daily activities such as eating, drinking, and speaking, as well as in facial expressions. Lower lip defects should be repaired to preserve lip function without disrupting the aesthetic harmony of the lips within the face. This goal is difficult for plastic surgeons because, for functional and aesthetic repair, it is necessary to replace the mucosa, muscle (especially contractile), and skin tissues present in the lip.
Subtotal lower lip repair was performed using an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap in seven male patients with a mean age of 63 years. A depressor anguli oris muscle flap was used to repair the orbicularis oris muscle defect. The desepithelialized part of the reverse superior labial artery flap was used for mucosal defect repair, whereas the remaining part was used for skin defect repair. Patients were followed up for an average of 15 months. Patient lips, epithelialization, sensation, and sphincter function were clinically evaluated. Electromyography (EMG) was performed at 6 and 12 months to evaluate the function of the depressor anguli oris muscle flap.
All the reverse superior labial artery flaps survived without any loss. Trapdoor deformity developed in the flaps of two patients. The desepithelialized parts of the flaps were completely epithelialized (covered with mucosa) by approximately 6th week. In the EMG controls of the patients at 6 months, the depressor anguli oris muscle was contractible. Sensation regained in the operated lip during the follow-up period.
The combination of an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap is an important surgical option for the functional and aesthetic repair of subtotal lower lip defects.
下唇是参与日常活动（如进食、饮水和说话）以及面部表情的重要解剖结构。下唇缺损应进行修复，以保留唇功能，同时不破坏面部唇部的美学和谐。对于整形外科医生来说，这个目标很难实现，因为为了进行功能和美学修复，需要替换唇中存在的粘膜、肌肉（特别是收缩肌）和皮肤组织。
七名男性患者平均年龄为 63 岁，采用带神经的降口角肌肌瓣和去上皮化的上唇动脉逆行皮瓣进行部分下唇修复。降口角肌肌瓣用于修复口轮匝肌缺损。去上皮化的上唇动脉逆行皮瓣的部分用于修复粘膜缺损，其余部分用于修复皮肤缺损。患者平均随访 15 个月。对患者嘴唇、上皮化、感觉和括约肌功能进行临床评估。在 6 个月和 12 个月时进行肌电图（EMG）检查，以评估降口角肌肌瓣的功能。
所有上唇动脉逆行皮瓣均存活，无任何丢失。两名患者的皮瓣出现了活瓣畸形。皮瓣的去上皮化部分在大约第 6 周时完全上皮化（被粘膜覆盖）。在患者的 6 个月 EMG 对照中，降口角肌是可收缩的。在随访期间，手术唇的感觉恢复。
带神经的降口角肌肌瓣和去上皮化的上唇动脉逆行皮瓣的组合是修复部分下唇缺损的重要手术选择，可实现功能和美学修复。
