皮下组织瓣修复单侧唇裂术后继发唇珠缺如和鼻底凹陷

Secondary correction of median tubercle deficient in vermilion and nostril-bottom deformity with subdermal soft tissue flaps after uilateral cleft lip repair

目的探讨修复单侧唇裂术后继发唇珠缺如和鼻底凹陷的方式和方法,提高单侧唇裂术后继发畸形治疗的效果。方法回顾性研究2011年6月至2012年10月,解放军第二炮兵总医院收治的单侧唇裂术后继发上唇畸形36例患者,应用患侧上唇皮下口轮匝肌和瘢痕设计并形成"C"瓣和"D"瓣,"C"瓣转移至患侧鼻翼基底,修复鼻底凹陷畸形,同时可以向内、上收紧向下、外移位的鼻翼外侧脚;切缘口轮匝肌于患侧人中嵴处对合,重建口轮匝肌连续性;"D"瓣向健侧反转再造唇珠,修复唇珠缺如畸形。结果回顾性研究36例患者术后伤口愈合良好,鼻底、唇部形态明显改善,唇珠明显,上唇形态自然,与下唇关系协调。其中28例随访6个月～1年,上唇形态持久、满意。结论由患侧上唇皮下瘢痕和口轮匝肌构成的皮下组织"C"瓣和"D"瓣,可以改善鼻底凹陷,加强唇珠形态;两侧口轮匝肌在中线对位缝合可以重建口轮匝肌连续性,上唇形态更加趋于正常,治疗效果确切。

Objective To investigate an effective method for the correction of nostril-bottom deformity and median tubercle deficient in vermilion secondary to unilateral cleft lip. Methods Unilateral subdermal soft tissue ＂C＂ flaps and ＂ D＂ flaps were designed on the affected lips. The ＂C＂ flaps were transferred to the alar bases to repair secondary nostril-bottom deformities of the nasal bases. The orbiciclaris otis muscles on both side of the incisions were sutured together to make them continuous. The ＂D＂ flaps were rotated back to the middle side to reconstruct or argument the vermilion tubercles. Results Thirty-six patients were treated with this method. All the cases achieved good shapes of median tubercles and nostrils. The good healing was found in all the cases. No flap necorosis was noted. Twenty-eight cases were followed up for 6-12 months with good cosmetic result and no recurrence. Conclusions With unilateral subdermal soft tissue ＂C＂ flaps and ＂D＂ flaps, nostril-bottom deformities and deficient median tubercles were corrected. It is an ideal method for correction of deformities of the lip after unilateral cleft lip repair.