自创肌肉卷瓣法加人中沟成形术重建唇裂术后人中嵴及人中

Reconstruction of philtrum crest and philtrumwith orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing

目的探讨唇裂二期修复术中一种可靠易行的人中嵴及人中成形的方法。方法2008年7月至2021年11月,南方医科大学南方医院整形美容外科收治唇裂术后继发鼻唇畸形患者201例,男85例、女116例,年龄14~35岁,平均22.4岁。切除上唇瘢痕掀开上唇皮瓣,以重建人中嵴处为蒂分离患侧皮下异常肌性隆起处的浅层口轮匝肌,由外侧向内掀起舌状肌肉瓣并纵行卷曲,与人中沟处纵行切开外翻的浅层口轮匝肌瓣对应缝合,固定于重建人中嵴位置上,与加深人中沟共同形成隆起的人中嵴和明显的人中沟外观。结果201例患者早期外形改善明显,重建人中嵴外形逼真,人中区结构清晰,无皮瓣坏死、感染等并发症发生。随访1~36个月(平均7.8个月),198例人中嵴和人中沟的明显度有不同程度地减弱,但3个月后仍存在。98例患者随访>3个月,显著改善78例(79.6%)、基本改善12例(12.2%)、改善不明显8例(8.2%)。结论肌肉卷瓣法加人中沟成形术重建人中嵴及人中的方法操作简便,不需填充材料,术后效果较稳定且满意度高,可作为唇裂术后继发畸形的人中嵴及人中的优选矫正方案。

Objective To introduce a reliable and easy method of philtrum crest and philtrum repairing in secondary repair of cleft lip.Methods Lift the upper lip flap after removing the scar on upper lip.Then the superficial orbicularis oris muscle was carefully separated,which formed the abnormal muscular eminence in the affected side after the first cleft lip repair.The pedicle of the orbicularis oris muscle the reconstructing philtrum crest.The lingual orbicularis oris muscle flap was lifted and curled from outside.The superficialorbicularis oris muscle was cut in philtrum longitudinally and turned outward.The two evertedorbicularisoris muscle flaps were sutured on both sides and fixed them on the reconstructing philtrum crest.The exposed deep orbicularis oris muscle in philtrum was sutured with the upper dermis,which formed the prominentphiltrum crest and deeper philtrum.Results We reviewed the hospital records of patients from July 2008 to November 2021.In total,201 patients were included in this study.All of these patients underwent the reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing.During the treatment,the patients had no complications such as infection,hematoma and flap necrosis.198 patients were observed from 1 months to 36 months(7.8 months on average).All of them improved in different degrees in early postoperative period.Most reconstructed philtrum crest was raised and basically symmetrical with the contralateral side in shape.The philtrum was clear and the scar was not obvious.The reconstructed philtrum crest would decrease with time.91.7%(90/98)patients were satisfied with the postoperative effects after three months.Conclusions The method of reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing is safe and effective.The long term postoperative effect is stable with high satisfaction as well.As a result,this method can be used as the philtrum crest and philtrum correction scheme for secondary cleft lip repairing.