双侧“V”形唇红瓣联合口轮匝肌成形术修复双侧唇裂术后凹陷畸形

目的探讨双侧唇裂修复术后继发红唇凹陷畸形的有效矫治方法。方法本组患者26例,均为双侧唇裂一期手术后。术中,首先切除原有瘢痕,解剖分离出两侧口轮匝肌,重建连续的口轮匝肌肌环;然后在双侧红唇瓣上分别设计＂Y＂型切口,三角瓣尖端朝向中线;最后将双侧＂V＂型三角黏膜瓣向中线推进交叉缝合,重建唇珠。结果 26例患者红唇口哨畸形均得以矫正,上唇人中得以延长。所有患者术后随访3个月至2.5年,效果良好。结论在口轮匝肌重建基础上,应用＂V＂型皮瓣推进交叉成形术,是种操作简单、效果良好的修复双侧唇裂术后继发红唇凹陷畸形的方法 。     

双侧唇裂直接修复法的一点改进

双侧唇裂直接修复法具有设计及操作简便,术后近期外观较好,但鼻底易裂开或形成凹陷,前唇常形成弧岛状畸形,为此,我们在前唇两侧各增加一个三角瓣插入鼻底,避免鼻底裂开及凹陷;将两侧口轮匝肌交错缝合,恢复口轮匝肌的连续性,防止弧岛状畸形的形成;两侧唇红瓣在前唇下交叉,相互镶嵌缝合,以弥补前唇部红唇厚度不足。作者应用于6例患者,效果满意。本文介绍了手术方法,并对继发畸形的成因和改进进行了分析讨论。     

双侧推进肌蒂红唇肌瓣修复双侧唇裂术后口哨畸形

目的 探讨双侧推进肌蒂红唇肌瓣在双侧唇裂术后口哨畸形修复中的应用。方法 在双侧唇裂术后口哨畸形的两侧红唇上设计切口线，按切口线，先用11号尖刀片切除口哨畸形正中处黏膜，止血、分离。然后，切开两侧上唇前面约1／3厚的口轮匝肌，在唇动脉的后方切开口轮匝肌，以保持红唇肌瓣有良好的血供，解剖完成之后，形成以上方轮匝肌为蒂的两个楔形的红唇肌瓣相向推进移转，按“V-Y”原则相互在中线形成唇珠，口哨畸形消失。结果 已用该法修复11例，上唇高度和宽度适中，有明显的唇珠，整个上唇解剖结构近似正常。结论 用该法修复术后口哨畸形，不需要从身体其他部位转移组织，即可得到满意效果。     

双侧唇裂直接修复法的一点改进

双侧唇裂直接修复法具有设计及操作简便，术后近期外观较好，但鼻底易裂开或形成凹陷，前唇常形成弧岛状畸形，为此，我们在前唇两侧各增加一个三角瓣插入鼻底，避免鼻底裂开及凹陷，将两侧口轮匝肌的连续性，防止弧岛状畸形的形成，两侧唇红瓣在前唇下交叉，相互镶嵌缝合，以弧补前唇部红唇厚度不足，作者应用于６例患者，效果满意。     

改良皮肤切口及口轮匝肌功能性复位在双侧唇裂修复中的应用

目的：探讨修复双侧唇裂的方法和临床效果。方法：2008年4月～2009年2月我科采用改良皮肤切口及口轮匝肌功能性复位对23例双侧唇裂患儿进行手术修复。该方法通过设计侧唇的皮肤红唇粘膜三角瓣插入前唇皮肤粘膜交界处,以补充前唇的组织量,再造唇弓和唇珠。同时重建口轮匝肌的连续性。结果：术后随访1～6个月,23例双侧唇裂患者术后双侧唇高、鼻翼和唇红对称,鼻孔等大,鼻堤明显,无鼻底凹陷,唇弓自然,效果满意。结论：此法修复双侧唇裂能较好地恢复口轮匝肌的连续性、再造唇弓和唇珠,具有设计简单易行,切除组织量较少,瘢痕较小,术后形态功能俱佳的特点。值得临床上推广应用。     

缺损两侧的唇黏膜瓣在修复上唇中部红唇凹陷性缺损中的应用

目的探讨缺损两侧的唇黏膜瓣在上唇中部红唇凹陷性缺损畸形修复中的应用价值。方法在上唇中部红唇凹陷性缺损两侧，红唇与黏膜交界处内侧设计横行反向三角形黏膜瓣，两瓣共蒂于红唇凹陷部位。在缺损正中后部，黏膜瓣画线下方设计“人”形切口。沿设计线切开，掀起黏膜瓣，在该瓣下及两侧上唇切口下方稍加游离口轮匝肌．使其有一定移动度。将两侧口轮匝肌在掀起的黏膜瓣蒂下方正中处对拢缝合。然后将两侧黏膜瓣向下旋转90°，插入其下的“人”形切口内，使上唇中部组织量进一步增加，并加深唇龈沟，而两瓣移植后的共同蒂部“猫耳”正好形成唇珠，逐层缝合切口。结果共26例，其中双侧唇裂术后继发红唇缺损18例，尊侧唇裂术后继发红唇凹陷畸形4例，先天性4例，术后伤口均I期愈合。修复后红唇凹陷处饱满，唇珠明显，上唇外形满意，手术瘢痕小明显。结论应用缺损两侧的唇黏膜瓣转移修复上唇中部红唇凹陷性缺损畸形及唇珠再造，为同类组织修复，效果理想、操作简便、应用范围广泛，对任何原因引起的上唇中部红唇凹陷性缺损畸形均可应用。     

双侧唇红矩形瓣前唇原长双侧唇裂修复术

目的介绍双侧唇红矩形瓣前唇原长双侧唇裂修复术的应用。方法双侧唇裂患者29例,男性20例,女性9例。其中双侧完全裂15例,不完全裂11例,混合裂3例,均采用双侧唇红矩形瓣前唇原长法进行修复。首先采用传统的原长法原则修复唇白。修复唇红时,在两侧唇红设计形成包括黏膜和部分口轮匝肌的矩形瓣,并沿干湿唇交界线水平切开前唇,将两侧矩形瓣向下内旋转至前唇唇红对接缝合。缝合时口轮匝肌肌束的断端尽可能广阔而平整的接合,以恢复正常的环形结构。结果所有患者的创口均Ⅰ期愈合,上唇高度宽度适中,唇珠明显,无口哨畸形。结论该方法修复双侧唇裂,方法简单可靠,去除组织少,术后能获得较好的鼻唇外形,口唇功能较好,值得在临床推广。     

侧唇唇缘红唇肌瓣再造双侧唇裂患者唇珠及唇缘

目的:利用侧唇重要的解剖学指标,再造双侧唇裂人中部唇缘及唇珠,探求一种有效的功能性修复双侧唇裂唇缘及唇珠的方法。方法:2000年～2005年本院收治的唇裂患者中,双侧唇裂患者76例,男性54例,女性22例。年龄最大19岁,最小4/12岁。通过设计侧唇唇缘红唇肌瓣,旋转于前唇下方重建唇弓缘,该瓣末端红唇粘膜肌瓣再造唇珠的方法修复。结果:术后患者无1例裂开,无明显的口哨畸形,口轮匝肌连续完整,唇弓缘连续,唇弓自然生动,形态好。红唇丰满,红线连续,唇珠突翘明显。结论:唇缘红唇肌瓣可以较好地修复双侧唇裂下部重要解剖结构,唇缘红唇肌瓣的设计切取是手术成功的关键。     

双侧唇裂术后上唇短小合并鼻畸形的治疗

目的：探讨双侧唇裂术后上唇短小合并鼻畸形的矫正方法。方法：将前唇整块上移延长鼻小柱,双侧外侧唇颊瓣向中线推进,Ⅰ期修复唇部组织缺损,恢复口轮匝肌的连续性,同时矫正鼻尖低平、鼻孔宽大、重建人中嵴。结果：临床治疗7例,术后切口均Ⅰ期愈合,随访10天～24个月,唇、鼻畸形明显改善。结论：利用前唇上移和双侧外侧唇颊瓣推进是解决上唇短小合并鼻畸形的一种有效方法。     

口轮匝肌重建联合黏膜V-Y成形修复双唇裂术后红唇凹陷畸形

目的 探讨口轮匝肌解剖重建联合前唇黏膜"V-Y"成形术修复双唇裂术后中央部红唇凹陷畸形的手术方法.方法 对16例双唇裂术后前唇凹陷畸形者行前唇部红唇"V'形切口,解剖分离出红唇两侧口轮匝肌并缝合,将前唇黏膜瓣"Y"形缝合,使前唇丰满.结果 患者红唇凹陷畸形得到矫正,红唇形态良好,静态与动态畸形矫正效果满意.随访2个月至2年,远期疗效稳定.结论 红唇部口轮匝肌解剖重建联合前唇黏膜"V-Y"唧成形术,是一种操作简单、效果稳定的功能性修复双唇裂红唇凹陷畸形的较好方法.     

Scarless lip rehabilitation for the adynamic lip.

OBJECTIVE: Paralysis of the marginal mandibular branch of the facial nerve can be a debilitating condition resulting in compromised speech and oral incompetence. We describe a static procedure performed to address the functional and cosmetic deficits seen with an adynamic lip. METHODS: Three patients with complete facial nerve paralysis were evaluated after the scarless lip rehabilitation, a modification of the traditional wedge resection of the lower lip. The procedure is novel in that the removal of lip laxity and advancement of the contralateral innervated lip is achieved without an external facial skin incision. RESULTS: All 3 patients in the study reported improvement in oral competence and lip symmetry; however, articulation was less consistently affected. All 3 patients were able to drink from a glass without leaking from their oral commissure. No complications were seen in this series of patients. CONCLUSION: Oral incompetence and asymmetry are often the overlooked sequelae from complete facial nerve paralysis. Scarless lip rehabilitation of the adynamic lip is a novel, safe, and effective means to improve these functional and aesthetic deficits.     

Quantitative analysis of lip appearance after V-Y lip augmentation

OBJECTIVE: To quantitatively analyze the changes in the 3-dimensional appearance of the lips after V-Y lip advancement for lip augmentation. DESIGN: A retrospective single-blinded study of patients who had a V-Y lip augmentation from January 1999 to December 2001. Standardized anterior and lateral preoperative and postoperative digital photographs of patients were analyzed using digital imaging software to quantify postoperative changes. RESULTS: There were statistically significant increases in the vertical height of the upper red lip (75%) and in the area of the upper red lip (66%). The upper and lower lip projection increased by approximately 40%. The vertical distance from the apex to the trough of Cupid's bow increased by 56.7%. CONCLUSIONS: The V-Y lip advancement for lip augmentation increases the parameters that characterize the fullness of the upper lip and enhances the vermilion "pout" and projection of the upper and lower lip. It also increases the curvature of Cupid's bow.     

以唇动脉为蒂的唇瓣修复中度和重度唇全层缺损

目的探讨中、重度全层唇缺损的修复方法.方法在缺损一侧或两侧(若缺损较大,一侧唇瓣不够用时)设计以唇动脉为蒂的唇瓣向缺损区推进转移修复全层唇缺损.若缺损较大,单纯用缺损两侧口唇组织仍不足以修复时,可将一侧唇瓣向外侧延伸绕过口角至另一侧上或下唇(根据缺损是在下唇或上唇),形成包括上下唇组织在内的大型唇瓣向缺损区推进修复缺损.若缺损为单纯的红唇缺损,唇瓣切口应沿唇弓设计.结果临床应用于67例,其中上唇38例,下唇29例.缺损最大水平宽度3.5 cm,最小1.6 cm.单纯红唇瓣20例,红白唇瓣47例.单侧唇瓣10例,双侧57例.所有唇瓣均全部存活,伤口Ⅰ期愈合,修复后的口唇丰满,外形满意.结论唇动脉血管恒定,唇瓣血供可靠,本法不仅能用于单纯红唇缺损的修复,还可广泛用于红、白唇同时缺损的修复,因是用同类组织修复,且组织量丰富,故术后能完全恢复口唇所特有的红、白唇结构及功能,是修复中、重度全层唇缺损的理想方法.     

Bilateral cleft lip

Directing the course of care for a patient with bilateral cleft lip problems is a great responsibility and challenge for the surgeon, and it requires full commitment, effort, and talent. The goal is to enable the patient to develop anatomically, functionally, and psychologically as normally as possible and to achieve and succeed in life according to natural abilities, unimpeded by the congenital deformity complex. An individualized and organized effort must continue until the child is grown. One important aspect of this effort is the technical cleft lip repair. No matter how well done, perfection is always a step away. Open minds and energetic young students should be reluctant to accept the "status quo"; they should be encouraged to accept this challenge and make contributions. Although many other "big, new" operations may be very dramatic, none will be more satisfying to the surgeon than the well-performed bilateral cleft lip repair. The surgeon must remember that the day of cleft lip repair is one of the single most important days of a person's life. The result will have meaning from that moment on!     

The sensuous lip

The author uses Zyplast to help increase the volume of the upper or lower lip. It is emphasized that there is a clear bilobulation of the lower lip which creates the appearance of a beautiful mouth. His injection of Zyplast demonstrates a technique that helps to emphasize this bilobulation.     

Cleft lip repair

Summary The method is a modification of that of Millard and involves a small triangular flap on the end of the vermilion ridge. This approach provides continuity of the vermilion ridge, and promotes a natural appearance of the upper part of the philtrum on the cleft side. This surgical technique is applicable for all complete or incomplete unilateral cleft lips.Presented in part at the Second Congress of the Asian Pacific Section of the International Confederation for Plastic and Reconstructive Surgery, Tokyo, August 24, 1977     

Mimicking lip features in free-flap reconstruction of lip defects.

This paper introduces a technique of lip reconstruction using free flaps in which recognisable landmarks are mimicked by strategic placement of flap junctions. The technique was applied in 15 patients undergoing reconstruction of combined cheek and lip defects using single (n= 9) or double (n= 6) free flaps. Attention to flap design and strategic placement of flap junctions successfully created the vermilion-cutaneous junction, oral commissure and labiomental groove. The presence of these distinguishing features improved the appearance of the reconstructed lip.