轴型唇红组织瓣并颏下唇粘膜蒂肌皮瓣修复下唇缺损

THE TISSUE-EXPANDING VERMILION FLAP AND CHIN-LOWER LIP MYOCUTANEOUS FLAP OF MEMBRANE PEDICAL FOR LOWER LIP REPAIR

对于唇缺损的整复应尽可能地应用局部或邻近区域组织瓣来恢复它的正常解剖形态和生理功能已成为公认的基本原则。本文描述了一种整复下唇缺损的新的手术方法。该方法充分利用缺损后的唇红和白唇组织，恢复口轮匝肌和唇红的完整性，使唇缺损的修复效果达到了外形与功能的完美统一。本文就该手术方法的解剖学基础，手术操作要点以及手术的适应证等问题做了较为详尽的讨论。

It is a important principle that the defects of lower lip was repaired by using the tissues around mouth. This article introduced a new method for the repair of lower lip defect. First, according to the new surgical process, a triangular myocutaneous flap was designed between defect of lower lip and chin, pedicled by membrane of lower lip. The intraoral membranous pedicle of chin-lower lip myocutaneous flap were incised oblique vertically from the margin of defect to the bottom of labial vestibule. The chin-lower lip myocutaneous flap pedicled by intraoral membrane could be done. This flap was extended to reach the vermilion border and was reconstructed lower lip defect of skin. Then, vermilion of all layers should be incised along vermilion border and the incisions should be stretched to commissure of lip. Two vermilion flaps were formed pedicled by the vermilion tissues at each of the commissure of lip based on the lower lip artery. With using the elastic of vermilion tissues, the vermilion flap should be expanded for repairing vermilion defect of lower lip. And last, two expanded vermilion flaps were sutured end to end and the whole vermilion flaps were sutured along the edge of defect immediately. In 1947, Macomber and Berkeley gave the following reasons in support of the use of local flaps in facial reconstruction:Better color and texture match, production of minimal defect in the donor area, ideal thickness, proximity of tissue to be transferred, and greater vascularity. The tissue-expanding vermilion flap and chin-lower lip myocutnaeous flap pedicled by membrane described in this article have each of the advantages, with the addition of: 1) utilizing the remnants of the lower lip tissues (vermilion and skin),2) recoverring integrality of orbicular muscle of mouth and vermilion satisfactorily. A good clinical effect was achieved in practice. In the paper, the anatomic base of the new method, the surgical technique, the indication and so on were described and discussed in detail.