口轮匝肌瓦合法在修复单侧唇裂继发畸形中的应用

目的 探讨单侧唇裂术后继发畸形的患侧人中嵴的重建方法.方法 本组对36例单侧唇裂术后患侧人中嵴不显或凹陷的患者施行二期唇裂整复术时,在口轮匝肌功能复位的基础上,行瓦合法缝合修复患侧人中嵴处口轮匝肌,造成患侧人中嵴处口轮匝肌增厚,形成隆起的人中嵴外观.结果 本组36例患者经过人中嵴重建修复后,随访3～6个月,重建人中嵴形态逼真,术后形态满意.结论 单侧唇裂术后继发畸形整复时,在口轮匝肌功能复位的前提下,行人中嵴处口轮匝肌瓦合法缝合,使人中凹显现,重建人中嵴,可使上唇外形更为逼真、生动,值得临床推广应用.     

口轮匝肌垂直褥式缝合法重建人中嵴修复单侧唇裂术后继发畸形

目的 探讨单侧唇裂术后继发畸形患侧人中嵴的重建方法.方法 本组对60例单侧唇裂术后鼻唇畸形患侧人中嵴不显或凹陷的患者施行Ⅱ期唇裂整复术时,在口轮匝肌功能复位的基础上,利用患侧人中嵴处口轮匝肌垂直褥式隆起缝合,使患侧人中嵴处口轮匝肌较厚,皮肤缝合后患侧即形成隆起的人中嵴外观.结果 本组60例患者,经随访3～6个月,效果满意,重建人中嵴形态逼真.结论 单侧唇裂术后继发鼻唇畸形整复术中,利用口轮匝肌的功能复位加人中嵴处口轮匝肌垂直褥式隆起缝合,重建人中嵴,可使人中凹显现,上唇外形更为逼真、生动,值得临床推广应用.     

去表皮瘢痕组织瓣重建患侧人中嵴修复单侧唇裂继发畸形

目的：采用仿MillardⅡ术式矫正单侧唇裂继发畸形的同时利用上唇去表皮瘢痕组织瓣重建惠侧人中嵴。方法：2005年2月～2008年4月，对10例单侧唇裂继发畸形患者应用仿MillardⅡ术式矫正唇鼻畸形，同时利用C瓣携带的上唇去表皮瘢痕组织瓣重建惠侧人中嵴。结果：所有患者术后切口愈合良好，C瓣全部存活，未出现瘢痕组织瓣坏死。随访3-12个月，惠侧鼻小柱得到明显延长，两侧鼻孔基本对称。再造的人中嵴稍隆起、两侧对称、人中显现。唇弓形态改善，唇峰基本对称，红唇厚薄一致，术区瘢痕不明显。畸形矫治效果较术前明显改善。结论：应用仿MillardⅡ术式矫正单侧唇裂继发畸形的同时利用以C瓣供血的去表皮瘢痕组织瓣重建患侧人中嵴，使得以前需切除遗弃的组织得到充分利用，重建的人中嵴可使整复的上唇外形更为逼真、生动。临床实践证明此方法是安全可行的。     

单侧唇裂继发畸形修复中口轮匝肌的重建

目的介绍口轮匝肌复位重建在单侧唇裂继发畸形修复中的效果。方法对采用直线缝合法修复的唇裂患者，在行继发畸形修复中，选Millard旋转推进法设计皮肤切口，切开皮肤，将裂隙的健、患两侧的口轮匝肌进行解剖，在健侧，分离口轮匝肌达正常侧人中嵴处；在裂隙侧，将口轮匝肌从皮肤下解剖达10mm；在口腔裂隙的健侧从鼻棘，裂隙侧从鼻翼基部，将口轮匝肌从黏膜下分离出来。使用透明的尼龙线缝合肌肉。将裂隙健、患侧分离的口轮匝肌每侧水平分成4束，互相交叉缝合，然后缝合皮肤。结果术后患侧鼻孔大小、对称性、鼻小柱长度、鼻小柱的位置、患侧人中嵴、患侧唇峰、唇珠、人中凹、鼻尖的高度、突度的变化，术后均近似正常，近期效果满意。结论利用口轮匝肌的重建来修复单侧唇裂继发畸形，以恢复正常上唇正中解剖结构及对称的鼻孔大小，是一种有用的方法。     

口轮匝肌瓣垂直交叉法在继发唇裂人中嵴重建中的应用

在继发唇裂修复下术中，患侧人中嵴的修复对重建上唇的正常外观至关重要。已有多种手术方法报道，包括皮下旋转皮瓣或肌肉瓣、皮下耳软骨移植、肌腱移植以及下唇的Ahbe瓣等，但均存在供区受损或移植物吸收而影响手术效果等缺点。我们通过劈裂口轮匝肌后垂直交叉缝合重建自然的患侧人中嵴，取得了较好的效果。     

单侧唇裂修复术设计的改进

在单侧唇裂修复术中，要求重建对称的人中嵴．保存完整的人中窝和确切补充上唇因萎缩引起的组织量不足，Millard法重建的人中嵴上部倾斜^[1,2]。外侧三角瓣法破坏了人中窝的完整^[2]。Mobler虽然用直线法重建了人中嵴，保留了人中窝[3]．但在上唇缺损量大的情况下．对肌肉黏膜的补充量不确切．且其直线瘢痕也易导致术后上唇挛缩。并因皮     

应用鼻底三角瓣法修复单侧不完全性唇裂

目的 应用改进的鼻底三角瓣法修复单侧不完全性唇裂，以获得更加良好的上唇外形。方法 对单侧不完全性唇裂的首次手术，于患侧鼻底部设计三角皮瓣转移下降上唇，白唇部裂隙切口直线缝合。结果 66例患者修复后上唇外形良好，双侧上唇高度对称，人中形状完整。结论 鼻底三角瓣法适用于单侧不完全性唇裂的修复。     

Millard法结合下三角瓣法修复单侧完全性唇裂

探讨采用Millard法结合下三角瓣法修复单侧完全性唇裂的临床效果．方法：采用Millard法结合下三角瓣法修复单侧完全性唇袋26例，阐明该术式的方法、优点及手术中应注意的问题。结果：26例患者手术全部成功，上唇解剖形态恢复满意，上唇丰满．唇弓外形自然，患侧唇峰下降充足．唇上部紧张度较大，鼻小柱居中，惠侧鼻翼鼻孔外形恢复良好，鼻底丰满，人中嵴形态良好，直线状癜痕模拟人中嵴。结论：该方法集Millard法及下三角瓣法之优点，相互弥补其缺点，修复单侧完全性唇裂临床效果满意，手术是活性及难度较大，主要靠目测及临床经验．应在熟练掌握两种常用术式后选用。     

鼻前庭矩形瓣法单侧唇裂修复术

目的：探讨鼻前庭矩形瓣法修复单侧唇裂的临床可行性，评价该方法的优越性。方法：应用遵循整形外科原则的鼻前庭矩形瓣法对80例单侧唇裂患者行立体三维修复。术后对外观及功能进行评价。结果：所有病例均Ⅰ期愈合。随访6个月～3年，除3例患儿红唇唇珠欠丰满，2例患侧鼻翼扁塌，2例切口有轻微瘢痕增长外，其余病例静态、动态效果良好。所有病例患侧唇峰均下降充分，两侧唇峰对称，人中形态好，人中嵴的形态接近正常。修复后的上唇更为丰满、松动，红唇丰满，唇珠明显。结论：应用鼻前庭矩形瓣法进行单侧唇裂的立体三维修复，符合整形外科原则，且不牺牲人中部位的组织及破坏了人中嵴、人中窝等重要美容结构。手术效果良好，值得推广应用。     

单侧唇裂二期人中整形术

我们自 2 0 0 0～ 2 0 0 2年用自行设计的手术方法行单侧唇裂二期人中整形术 5例 ,效果良好。1　临床资料本组 5例 ,男 4例 ,女 1例。年龄 7～ 33岁 ,平均年龄17 2岁。共同临床特征是 :单侧唇裂术后 ,人中凹不明显 ,患侧无人中嵴 ,上唇患侧低平 ,欠丰满。2　方法术前设计如图 1(以下三角瓣法的手术瘢痕举例图示 ,其它修复术式的二期人中整形亦按此设计 ) :AB为健侧人中嵴 ,A′B′为与AB相对称的预形成的患侧人中嵴。采用双侧眶下孔阻滞麻醉。按照一期手术切口瘢痕 (C)切开患侧鼻底至唇弓缘的皮肤层 ,再将两侧唇峰间的唇弓缘切开 ,使两处…     

Modification of Reichert's technique based on natural landmarks and individual designs for unilateral repair of cleft lip.

We present a new technique for repair of unilateral cleft lip used in 230 patients. This is a modification of Reichert's technique for unilateral cleft lip repair. It is based in three concepts: form, severity, and natural landmarks of the lip. All the incisions are placed on natural landmarks, between the aesthetic subunits of the upper lip. The incision for rotation of the philtrum is designed to imitate the column of the philtrum on the normal side with good aesthetic result. We do not use a subnasal incision on the lateral side. Since 1996, we have used this technique in 230 unilateral cleft lip repairs. We obtained a good functional and aesthetic result in the nose and upper lip. Our failure rate was 14%. We describe Reichert's modified technique, named the Reichert-Millard's technique, with good aesthetic results (fewer scars and more individual designs than traditional techniques) for repair of the lip and nose in patients with unilateral cleft lip.     

Modification of Reichert's technique based on natural landmarks and individual designs for unilateral repair of cleft lip

We present a new technique for repair of unilateral cleft lip used in 230 patients. This is a modification of Reichert's technique for unilateral cleft lip repair. It is based in three concepts: form, severity, and natural landmarks of the lip. All the incisions are placed on natural landmarks, between the aesthetic subunits of the upper lip. The incision for rotation of the philtrum is designed to imitate the column of the philtrum on the normal side with good aesthetic result. We do not use a subnasal incision on the lateral side. Since 1996, we have used this technique in 230 unilateral cleft lip repairs. We obtained a good functional and aesthetic result in the nose and upper lip. Our failure rate was 14%. We describe Reichert's modified technique, named the Reichert-Millard's technique, with good aesthetic results (fewer scars and more individual designs than traditional techniques) for repair of the lip and nose in patients with unilateral cleft lip.     

唇裂的鼻小柱侧面皮瓣修复法

为唇裂患者塑造一个正常唇的美好形态,改进现在常用的手术对人中嵴,人中窝和朱缘弓这三种个重要美容结构的塑造中的缺欠,使修复后的嘎满,松动。方法在鼻小柱裂面形成一个矩形瓣,将其与人中一起垂直下降,被充裂侧唇人中的长度不 和保持朱缘弓在下降的正常位。     

改良单侧不完全性唇裂修复术的探讨

目的：探讨改良的单侧不完全性唇裂修复术式及人中嵴形态的修复方法。方法：根据患者两侧唇峰高度差分别选择两种不同的术式,对31例单倒不完全性唇裂患者进行恢复唇峰高度、修复口轮匝肌、重建人中嵴、矫治鼻畸形等方法进行综合修复。结果：分别采用两种术式中的一种修复的31例单侧不完全性唇裂患者上唇、人中嵴形态满意,部分接受鼻畸形矫治的患者,鼻畸形基本矫正,随访6个月～2年效果满意。结论：改良的唇裂修复术式用于单侧不完全性唇裂可取得满意的效果。     

Clinical investigation for bilateral cleft lip repair: modified functional bilateral cleft lip cheilorrhaphy.

PURPOSE: To obtain better operative results, a modified functional bilateral cleft lip (BCL) cheilorrhaphy was designed and used on 131 BCL patients to evaluate the clinical effectiveness in this clinical investigation. A new surgical method would be provided for BCL patients. PATIENTS AND METHODS: Based on the experiences and advantages of the commonly used self-longation and elongation surgical methods for BCL repair, a new surgical method was designed for BCL patients. During the operation, this modified functional BCL cheilorrhaphy emphasized the operative design, anatomy and reposition of musculus orbicularis orbis, management of the maxilla, and reparation of vermilion of the lip. This method was used to repair 131 BCL patients, and the conditions and results of errhysis, swelling, and healing of tresis vulnus were observed and evaluated. RESULTS: This modified functional BCL cheilorrhaphy was used successfully from January 2002 to July 2005 on 131 BCL patients. The wounds of all patients with BCL who joined this study healed very well without any hematoma, infection, or wound decohesion. All of the patients showed symmetric peak of Cupid's bow, obvious philtrum notch, full vermilion of the lip, little scarring, and satisfactory contour. During functional activity, bilateral upper lip was symmetric, coordinated, and balanced. CONCLUSIONS: The clinical results showed that modified functional BCL cheilorrhaphy may be accepted as a good selective surgical technique for BCL patients, and is worth generalization and application.     

Post-burn philtrum restoration

One of the consequences of face burn is upper lip deformation with philtrum injury. The philtrum's absence poses severe cosmetic defects. A literature review shows no effective developed technique which allows the surgeon to restore the upper lip and the philtrum in a single-stage procedure. The article presents a new method for burn-damaged philtrum restoration. Two scar stripes are deliberately left in place above the upper lip where the normal philtral ridges should be. The width of these two stripes (ridges) should be around 4 mm. The upper lip scars, lateral both ridges and between them, are excised forming the philtral dimple. The wound is covered with a split thickness skin graft. Two U-shaped sutures are led through the skin graft, both scar stripes and deeper through the underlying tissues between stripes. A bolster is plunged between the ridges in order to fill the dimple and is fixed by the tie-over dressing with tension. The skin transplant lying laterally to the ridges is covered with a separate tie-over dressing. The bolster is being kept in place for the duration of 7 days. As a result, the scar ridges preserve their height and the dimple keeps its depth. Good long-time follow-up results (up to 7 years) were observed in all 18 patients. In most cases the dimple can be slightly smoothed with time. The suggested method of philtrum restoration is an important component of the burned upper lip reconstruction as part of the post-burn facial resurfacing.     

应用鼻底三角瓣法修复单侧不完全性唇裂

目的　应用改进的鼻底三角瓣法修复单侧不完全性唇裂 ,以获得更加良好的上唇外形。方法　对单侧不完全性唇裂的首次手术 ,于患侧鼻底部设计三角皮瓣转移下降上唇 ,白唇部裂隙切口直线缝合。结果　 6 6例患者修复后上唇外形良好 ,双侧上唇高度对称 ,人中形状完整。结论　鼻底三角瓣法适用于单侧不完全性唇裂的修复     

Millard法修复单侧唇裂的分析和研究

目的：分析阐明Millard法在修复单侧唇裂中的优点和缺陷。方法：对30例单侧唇裂的患儿，应用Millard I或Ⅱ型法修复，同时在唇红缘裂隙处作一交叉三角辨的改良，并一期复位鼻翼软骨。结果：经6个月－1年的随访，解剖复位效果满意，瘢痕隐蔽，人中完整，唇红丰满，鼻翼软骨复位良好，鼻小柱得以延长。结论：Millard法是修复单侧唇裂较为理想的方法，应用交叉三角瓣修复唇红缘，弥补了Millard法唇红缘修复方面的不足。一期鼻翼软骨钝性解剖复位效果良好，符合东方人种的特点。     

改良Black术式对双侧唇裂前颌骨前突畸形的矫治

目的：探讨改良Black术式对于双侧唇裂前颌骨前突畸形的矫正作用。方法：选择20例病例,采用改良Black术式。手术切口的设计以Black术式为基础,在前唇设计2个“C”瓣,在两侧唇的唇峰及人中凹正中点设计矩形瓣。术前、术后半年及一年检查头颅正侧位片,测量对比前颅底平面与上齿槽座点之交角（SNA角）,以判定上颌前突畸形及外观纠正情况。结果：术前、术后半年及一年检查头颅正侧位片,测量对比SNA角,可见SNA角缩小明显,双侧唇裂患者外观纠正满意。结论：改良Black术式对于双侧唇裂前颌骨前突畸形具有较好的矫正作用。     

Two-stage unilateral cleft lip repair

Reconstruction of the unilateral cleft lip deformity remains a challenge. The Millard repair is the most commonly employed technique of lip closure. Wide clefts with malaligned alveolar arches and very short cleft-side philtral ridges are particularly difficult to reconstruct well. These cases frequently require some degree of cleft-side alotomy with attendant scarring and potential growth disturbance. Additionally, the lip scar tends to cross the philtrum at an aesthetically unsatisfactory low level. Nasoalveolar molding is one method to address these problems, but is not always available or practical. Alternatively, a two-stage lip repair serves as a reasonable means of managing these problems as well. The first stage, performed at approximately 4 to 6 weeks of age, is a full-thickness straight-line repair with tip rhinoplasty. The second stage is a modified Millard repair done at approximately 6 months of age. An alotomy is never needed. The lip scar does not cross the philtrum until the nasolabial crease. The alveolar segments are passively brought closer together by the early lip repair facilitating anterior palate closure. This technique has been used for more than 10 years with satisfying aesthetic and functional results.