Wave technique for treatment of lower lip cancer

PurposeThis article reports the authors’ experience with treatment of lower lip cancer using the wave technique.Patients and methodsTwenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used.ResultsNo recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia.ConclusionsWe modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.     

Treatment of lower lip cancer: an experience of 48 cases

The article reports results obtained in 48 cases of lower lip cancer. Tumor classified as T1 or T2, requiring a resection up to 60% of the lower lip, were treated with the stair-case technique. Nine patients were treated with the bilateral symmetrical stair-case technique since their lesions were located medially, while 23 were treated with the bilateral method using two asymmetrical flaps because their lesions were in paramedian position but larger than 2 cm. Ten patients required a unilateral flap. The cases classified as T3, in which the lesion required resection of more than 60% of the lip, were treated with the Bernard-Freeman-Fries technique.     

Yu's flap for lower lip and reverse Yu's flap for upper lip reconstruction: 20 years experience

Reconstruction of defects of the lip caused by cancer with its requirements of a complicated anatomical structure, important physiological function, and acceptable cosmetic result, is a challenge for oral and maxillofacial and plastic surgeons. A method that combines rotation and advancement flaps was described by Yu in 1989 for the reconstruction of defects of the lower lip. In our department between January 1992 and December 2012, 8 patients had reverse Yu flaps for the reconstruction of upper lip defects and 56 patients had classic Yu flaps for lower lip defects. Patients with defects located laterally to the upper lips, ranging from ? to ½, had unilateral reverse Yu flaps, and bilateral procedures were done for defects of less than ? of the lips. However, if the defects were located in the centre of the upper lips, between ? and ½, they were treated with bilateral reverse Yu flaps. Patients with defects between? and ? of lower lips had unilateral Yu flaps, and if the defects were wider than ? of the lower lips, the procedure was bilateral. No flap failed and desirable functional and aesthetic outcomes were recorded in all cases. Here we report our experience with the Yu flap for the benefit of other surgeons.     

Upper lip reconstruction with the alar crescent flap: A new approach.

PURPOSE: The alar crescent advancement flap technique has been widely used for repair of large central defects of the upper lip and base of the nose because of its 1-stage procedural simplicity and good results. Several more complicated and multiple staged procedures that respect either structure or function, often compromising one to achieve the other, have become popular and have recently taken its place. However, these procedures are more complex and in many cases require a staged approach. In this study, we present a series of 33 patients who underwent reconstruction of large upper lip defects utilizing alar crescent flaps between 1992 and 2002. PATIENTS AND METHODS: A series of 20 patients underwent reconstruction of large upper lip defects using alar crescent flaps between 1992 and 2002. Malignant etiologies were responsible for the defect in all patients. Reconstruction was performed as a 1-staged procedure in 19 cases. In 1 patient with a total upper lip defect, bilateral alar crescent flaps were used in conjunction with a cross lip flap that was later divided in a second stage procedure. RESULTS: All patients tolerated the procedure well with no major complications. Minor complications not requiring surgical intervention occurred in 5 patients. During the 12- to 60-month follow-up, all patients were found to be satisfied with the functional result. However, 7 patients underwent minor surgical procedures for esthetic improvement. There was no recurrence of disease in the 20 patients who underwent resection of malignancy. CONCLUSIONS: In these 20 cases, we have shown the utility of the alar crescent flap for varying length partial and full-thickness reconstruction of upper lip defects. This simple and straightforward technique provided good functional and esthetic results. The disadvantage of this procedure is the loss of philtral anatomic detail. Its primary advantage is that it is a single-stage procedure with a relatively low morbidity and patient inconvenience. As a single-stage technique it satisfies concerns over cost containment over more complex and staged procedures while still providing a good functional and cosmetic result. Furthermore, for those same reasons, this procedure is a good first choice in the elderly.     

Reconstruction of perioral defects following resection for oral squamous cell carcinoma.

PURPOSE: The aim of this study was to review and describe techniques for the reconstruction of large, complex perioral defects after resection of oral squamous cell carcinoma with emphasis on cosmetic and functional outcome. PATIENTS AND METHODS: A review of techniques and selected case presentations using different flap designs for the reconstruction of large perioral defects following resection of squamous cell carcinoma was performed. The Bernard and Karapandzic flaps were used for large lower lip defects. A Zisser flap technique was used to reconstruct a large commissure defect. RESULTS: All reconstructed patients had acceptable functional results and healed without complication. The large lower lip defects were easily closed with the Bernard and Karapandzic flaps. The commissure defect was reconstructed using the Zisser technique. While cosmesis was acceptable in all cases, the commissure was the most difficult region to reconstruct with a favorable appearance. There were no flap failures. The Karapandzic flap led to greater rounding of the commissure area and the composite resection resulted in a lack of lower lip support that was improved with prosthesis. Function was noted to be excellent in the Bernard and Karapandzic flaps, with the patients able to purse lips and blow up balloon-type devices. CONCLUSION: The Bernard, Karapandzic, and Zisser flaps provide a predictable method to reconstruct large perioral defects following resection for oral cancer. Subsequent fabrication of a prosthesis can aid in lip support for the resected area.     

双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣功能性重建完全性下唇缺损

目的:评价双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣功能性重建完全性下唇缺损的效果。方法:对9例唇癌患者进行肿瘤切除术,并利用以颏神经血管束为蒂的双颏V-Y岛状推进皮瓣联合舌瓣功能性重建下唇缺损。结果:皮瓣存活率达100%。随访6～20个月,患者唇部功能、感觉正常,且形态美观;均无局部复发或淋巴结转移。结论:双颏神经血管蒂V-Y岛状推进皮瓣联合舌瓣是唇癌切除后造成完全性下唇缺损的理想功能性修复方法。     

Modified labial tissue sliding flaps for repairing large lower lip defects.

PURPOSE: Common flap techniques for reconstructing large defects in the lower lip are often destructive and complex and result in unsatisfactory function and appearance. This article describes a modified technique that uses sliding labial tissue flaps to avoid these problems. PATIENTS AND METHODS: Eight patients with lower lip carcinomas had defects ranging from one third to four fifths of the length of the lower lip after tumor resection. The defects were closed with sliding labial tissue flaps, taking advantage of the elasticity of soft tissue to reduce the loss of normal tissue. Patients were followed for 2 to 12 years. RESULTS: The functional and cosmetic results were good, and there were no intra- or postoperative complications. Some patients experienced tightness of the lower lip that disappeared within 6 months. Carcinoma did not recur in any patient after a median follow-up period of more than 5 years. CONCLUSIONS: This modified labial tissue sliding flap technique is simple, safe, functionally and aesthetically satisfactory, sacrifices little healthy tissue, heals rapidly, and requires no further revision. The technique is effective for repairing defects covering one third to four fifths of the lower lip.     

Nasolabial flap for the reconstruction of defects of the floor of the mouth

Nasolabial flaps can be used for local reconstruction of moderate defects of the anterior oronasal structures. In a 10-year period 59 flaps were used in 43 patients to cover defects of the nose, lip and anterior structures of the oral cavity (floor of mouth, tongue, alveolar process). The fate of 26 of the flaps used for reconstruction of defects of the floor of the mouth in 16 patients, were reviewed. All flaps, 6 uni- and 10 bilateral, were inferiorly based. Dehiscence, which occurred twice, and loss of one flap were the main complications. The indications and the technique are discussed. The nasolabial flap is a good alternative for the reconstruction of moderate defects of the floor of the mouth, especially in older patients and even after high doses of preoperative radiotherapy.     

应用双侧唇红黏膜滑行瓣修复双侧唇裂术后唇珠缺失5例报告

目的: 评价双侧唇裂术后唇珠缺失修复中应用双侧唇红黏膜滑行瓣再造唇珠的疗效。方法: 收集我科2015年3月—2017年5月收治的双侧唇裂术后唇珠缺失患者5例,男2例,女3例;年龄7~26岁,中位年龄13岁,平均14岁。于全麻下行双侧唇畸形矫正术,术中同期设计双侧唇红黏膜滑行瓣向下方滑行、转移再造唇珠,以达到再造唇珠、消灭口哨畸形的目的。结果: 术后切口均一期愈合,随访2~26个月,唇珠形态稳定,未再出现口哨畸形。整体上唇形态满意。结论: 双侧唇裂术后继发唇珠缺失、口哨畸形的修复方法较少,在唇红黏膜上保留原来需要被切除的瘢痕组织并通过适当修整、滑行、重建再造唇珠,消灭口哨畸形,可以得到稳定满意的效果,值得临床推广应用。     

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目的探讨游离皮瓣在全下唇及颏部大范围缺损修复重建中的应用价值及临床效果。方法 2007年7月至2013年3月,对中国医科大学口腔医学院口腔颌面外科收治的12例下唇癌根治术后及2例外伤造成的全下唇及颏部缺损患者,应用前臂皮瓣和股前外侧皮瓣同期修复。术后随访6个月至3年,并对患者修复后下唇外观和功能进行评价。结果 14例皮瓣全部成活,成活率100%。术后随访下唇癌患者肿瘤未见复发,14例患者均可进行基本正常的语言交流;12例可进普食,2例进软食;1例流涎,均无小口畸形。下唇及颏部外观患者均能接受。结论应用游离皮瓣修复全下唇及颏部缺损,方法安全可靠且成功率较高,根据下唇及颏部缺损范围选择合适修复方式可获得较好的口腔功能和外观。     

Double mental neurovascular V-Y island advancement flaps combined with tongue flaps for functionally reconstructing total lower-lip defects

Although several techniques have been described for lower-lip reconstruction, functional reconstruction of total lower-lip defects remains a challenge. This study investigated a functional reconstruction technique for total lower-lip defects. Nine lower-lip defects were reconstructed after cancer ablation using double mental V-Y island advancement flaps, based on mental neurovascular bundle combined with tongue flaps. All flaps survived completely. The patients were followed up for 6 to 20 months. The lip function and sensation were normal, and aesthetic appearance was satisfactory. No patient developed local recurrence or lymphatic metastasis. The technique of combining a double mental neurovascular V-Y island advancement flap with a lingual mucosal membrane flap is ideal for the functional repair of total lower-lip defects after cancer ablation.     

游离血管化复合组织瓣在口腔颌面部严重创伤性缺损畸形整复中的应用：11例临床分析

目的:探讨口腔颌面部严重创伤性缺损的显微重建特点及游离血管化组织瓣的临床应用效果。方法:回顾性分析福建医科大学附属第一医院口腔颌面外科2005—2018年收治的11例外伤致口腔颌面部组织严重缺损患者,均为复合型组织缺损,累及多个解剖区域（唇、颊、鼻、耳、颞部、颌骨等）,陈旧性损伤患者尚伴有严重的瘢痕形成及组织移位。全部病例采用游离血管化组织瓣进行修复,其中前臂皮瓣4例,腓骨肌皮瓣3例,侧胸皮瓣1例,股前外侧皮瓣3例。结果:11例患者均得到有效治疗,术后随访1~13 a,游离血管化组织瓣存活率100%。未发生皮瓣危象等并发症,10例患者对修复后面部外形和功能表示满意。结论:头颈外伤性缺损具有特殊性,显微外科技术在外形修复和功能重建中具有重要作用,尤其在局部邻近组织瓣无法完成修复的大型缺损中。精准评估伤情及软、硬组织缺损严重程度,选择合适的游离血管化组织瓣,是应用该技术取得良好疗效的关键。     

Lower lip repair using double opposing rectangular rotation flaps with reconstruction of the mentolabial groove and mental protuberance

The use of a rectangular flap is a well known technique for upper lip repair in cleft lip, but is less common for lower lip repair after tumour resection. We have found this type of flap to be favourable for lower lip reconstruction, especially for the lip to mental region. We describe herein an improvement to the technique in which two opposing rectangular flaps, with the length of one side equal to the vertical distance from the mentolabial groove to the vermilion border, were raised on the lateral sides of a U-shaped defect. Reconstruction was performed by interdigitation of the two flaps and a bilateral vermilion advancement flap. This new approach allows a distinct mentolabial groove and mental protuberance to be created by utilizing two opposing rectangular flaps and redundant tissue, without sacrificing sensation and muscle function. Our results suggest that the technique provides excellent functional and cosmetic outcomes in restoration of the lower lip in properly selected patients.     

颏下岛状瓣修复口腔颌面部缺损临床应用研究--附30例报告

目的：评价颏下岛状瓣修复口腔颌面部组织缺损的临床效果及其价值,为临床应用提供经验。方法：临床应用颏下岛状瓣修复口腔颌面部缺损30例,其中面部6例,颊部9例（伴下唇缺损1例,口角缺损1例）,舌部9例,口底2例,磨牙后区1例,硬腭1例,上唇1例,下唇1例。术后观察组织瓣生长情况以及修复效果。结果：男性患者组织瓣上生长胡须,2例静脉回流障碍,1例组织瓣坏死,其余成活良好。缺损部位修复后,基本恢复解剖形态和生理功能。结论：颏下岛状瓣是修复口腔颌面部组织缺损的一种良好方法。     

Deepithelialized mucosal-submucosal flaps to correct the "whistling lip" deformity

Many methods have been described for correction of the "whistling lip" deformity, a possible sequela of bilateral cleft lip repair. A technique is described that utilizes medially based deepithelialized mucosal-submucosal flaps to augment the central tubercle and to reduce lateral lip fullness. This technique is also useful for certain mucosal contour defects that follow unilateral cleft lip repair. Indications for applying this technique and its advantages, compared with other procedures, are described.     

颏部岛状组织瓣功能性修复全下唇缺损的临床观察

目的 探讨全下唇缺损的功能性修复方法并观察其临床效果.方法 6例下唇癌患者行外科手术治疗,术后下唇缺损4/5至全下唇缺损,设计以双侧颏神经血管束为蒂的颏部岛状组织瓣V-Y推进修复下唇全厚缺损,重建口轮匝肌.结果 术后组织瓣全部成活,随访3～14个月,肿瘤均无复发,唇外观良好,张口度接近正常,同时保留了良好的口周括约肌功能和口唇黏膜的正常感觉功能.结论 对于局限于唇红或唇红缘下方1 cm内的全下唇缺损,双侧须神经血管束为蒂的颏部岛状组织瓣V-Y推进修复方法是比较理想的功能性重建方法.     

应用下蒂型斜方肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损

目的:采用下蒂型斜方肌肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损,评价其临床效果。方法:在对斜方肌及其血供进行显微外科解剖学研究的基础上,利用颈横动脉浅降支为蒂,设计下蒂型斜方肌皮瓣,皮瓣转移修复因放射性骨坏死致口腔、颌面及上颈部软组织缺损9例,共11侧。术后随访1～6个月,观察皮瓣生长情况和患者张口度的变化。结果:临床应用该肌皮瓣修复口腔、颌面及颈部组织缺损9例,其中2例采用双侧肌皮瓣转移修复,除1块皮瓣远端部分表皮坏死外,其余皮瓣均完全成活,且术后患者张口度最大者增加2.5cm。结论:下蒂型斜方肌皮瓣修复口腔、颌面及上颈部组织缺损的效果良好,成功率高,方法可靠,操作简单,是一种治疗颌骨放射性骨坏死的理想方法。     

Prospective comparative study of lower lip defects reconstruction with different local flaps

Squamous cell carcinoma is the most common malignancy related to the lips (95%), and the lower lip is more commonly involved. Loss of tissue in the lower lip is treated with a variety of techniques, depending on the extension and location of the defect. This was a prospective case series. In this study, 41 patients with squamous cell carcinoma (30 males, 11 females) who were referred to Razi Hospital of Tehran University of Medical Sciences between 2007 and 2008 and underwent lower-lip reconstruction were included. Defects were divided into 4 groups: less than 30%, between 30% and 50%, between 50% and 80%, and more than 80%. Five different local flaps were used for lower-lip reconstruction. Karapandzic flap was used for 9 patients, double reversed-Abbe flap for 6 patients, Abbe-Estlander and step-ladder flaps for 8 patients, and 10 patients underwent reconstruction operation with reversed-Abbe flap. In comparison to reversed-Abbe flap and step-ladder flap, there were no differences functionally and aesthetically except that the step-ladder flap was a single-stage procedure, but the reversed-Abbe flap had 2 stages. There were no functional problems in patients with Estlander flap, but these patients complained of lip asymmetry. There were no functional complaints and aesthetic problems in patients with double reversed-Abbe flap at 3 months after the operation. In patients with 30% to 50% defect of the lower lip, there was no functional and aesthetic difference between Abbe flap and step-ladder flap. Estlander flap is a good choice for reconstruction of lateral or commissural defects of the lower lip. In patients with 50% to 80% defect, it is better to use bilateral reversed-Abbe instead of the Karapandzic flap.     

筋膜悬吊联合前臂皮瓣修复唇或口角缺损10例报道

目的：评价筋膜悬吊联合前臂皮瓣修复唇或口角缺损的形态和功能效果。方法：自2001年以来选择10例唇部和口角缺损病例,按照唇部和口角的缺损范围设计前臂皮瓣,皮瓣与受区行血管吻合,依照缺损长度取大腿阔筋膜或掌长肌腱,在折叠皮瓣内面行筋膜悬吊,将筋膜分别与失去连续性的口轮匝肌和颊肌对位缝合,从而使皮瓣拥有良好的外形,并恢复部分唇部及口角的功能。结果：前臂皮瓣辅助筋膜悬吊后,随访2a以上,皮瓣100％成活,2例患者有轻度的唇部及口角闭合不全,其他患者口角修复外形、发音、咀嚼等基本正常．并可以辅助完成一定的表情功能。结论：采用筋膜悬吊联合前臂皮瓣修复唇或口角缺损,在形态和功能恢复方面有一定优势。     

双侧唇裂术后唇鼻畸形的美容整形术

目的 :探讨双侧唇裂继发畸形美容整形术的技术改进。方法 :采用两侧红唇上缘的小三角瓣插入到原人中的下方来延长上唇 ,及利用 2种方案修复鼻畸形。结果 :双侧唇裂术后唇鼻畸形Ⅱ期美容整形术12例均取得了比较明显的手术效果。结论 :此方法在唇峰重建、唇珠再造、人中凹形成及唇鼻畸形的矫正方面有比较独特的效果