新型断层肌黏膜蒂交叉唇瓣修复双侧唇裂术后继发畸形的临床效果

Correcting the secondary bilateral cleft lip deformities using an innovative partial-thickness muscuiomuco- sal pedicle cross-lip flap

目的评估应用新型断层肌黏膜蒂交叉唇瓣修复双侧唇裂术后继发畸形的临床效果。方法自2009年7月至2015年6月，应用新型断层肌黏膜蒂交叉唇瓣对98例患者进行双侧唇裂术后继发畸形矫正，根据上唇缺损情况设计相应的下唇断层交叉唇瓣，切断双侧下唇动脉，于口轮匝肌深层掀起断层肌黏膜瓣，注意保护垂直向小血管网。将其水平旋转180°并向上翻转填补上唇缺损；并根据畸形程度对双侧唇裂术后继发的上唇缺损进行重建。结果Ⅰ期术后，98例患者肌黏膜蒂断层交叉唇瓣全部成活。Ⅱ期术后，98例患者均对术后效果满意。结论新型断层肌黏膜蒂交叉唇瓣血运可靠，具有更大的灵活性和可塑性，可以对双侧唇裂术后继发畸形进行美学修复。

Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip. We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap. Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities. The central defects usually occurred in these patients. The defects were reconstructed partially or completely according to the severities of the defects. The operative procedures were as follows.. The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided. Then the partial-thick- ness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect. Results All 98 musculomucosal pedicle flaps were viable. The upper lips were reconstructed according to the severities. Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity. It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities.