相对唇粘膜口轮匝肌瓣修复口角红唇缺损

目的：为口角处红唇缺损的修复、提供一种简单有效的手术方法。方法：据唇红组织缺失大小,在缺损的红唇相对的唇粘膜设计蒂在同侧口角的唇粘膜口轮匝肌瓣,旋转至红唇缺损部位,唇粘膜口轮匝肌瓣供区直接拉拢缝合。结果：2009年以来,采用本术式共治疗上下唇近临口角处红唇缺损18例,随访3～6个月,所有唇粘膜口轮匝肌瓣全部成活,修复后的红唇形态及感觉良好。结论：唇部血运丰富,组织丰厚,口角的唇粘膜口轮匝肌瓣长宽比可适当增加,成活率高,简单易行,术后不需二期断蒂,减轻患者的痛苦,为临近口角处红唇缺损修复提供了较为理想的治疗方法。     

上唇红唇缺损畸形修复手术方法的选择

目的探讨口轮匝肌/颊肌黏膜瓣在一期修复上唇红唇缺损畸形中的应用效果。方法根据红唇缺损部位及面积,在颊部设计蒂在口角内侧的颊肌黏膜瓣,或在下唇红唇设计蒂在口角内侧的红唇口轮匝肌黏膜瓣,深达肌肉浅层,通过局部旋转的方法一期修复上唇红唇缺损,供区直接缝合,重建红唇正常形态和功能。结果本组共16例患者,术后随访6~24个月。术后红唇形态饱满对称,口角无破坏,无开闭口功能障碍,供区瘢痕不明显。结论采用颊肌/红唇口轮匝肌黏膜瓣修复红唇缺损,血运可靠、操作简单、治疗周期短,可以根据患者具体特点选择适合的手术方式。     

应用岛状颊肌粘膜瓣修复部分舌缺损

目的：探索一种用相同或相似组织修复舌缺损的方法，介绍岛状颊肌粘膜瓣修复部分舌缺损的经验。方法：应用以面动静脉为蒂的岛状颊肌粘膜瓣修复16例舌癌切除后的部分舌缺损。结果：16例患者术后岛状颊肌粘膜瓣全部完全成活，效果满意。无血肿、感染、腮腺导管损伤、面神经损伤和开口功能障碍等并发症，舌的形态、功能良好。1例半舌切除后的患者术后肌电图显示，颊肌粘膜瓣内的肌肉获得神经再支配且运动良好。结论：面动静脉岛状颊肌粘膜瓣组织学上类似于舌组织，血运丰富，转移灵活，可以获得神经再支配，有重建舌的运动功能的潜能，是修复舌缺损的一个良好选择。     

颊肌粘膜瓣修复红唇缺损3例

目前红唇缺损有多种治疗方法，红唇的重建需要注意达到颜色质地都相匹配的目的。本文探讨以面动脉前颊支为血管蒂的颊肌粘膜瓣修复红唇缺损的方法，此方法适合红唇及口轮匝肌缺损的病例。我科自2008年1月-2008年10月临床应用3例，效果良好，现将临床体会报道如下。     

应用颊肌粘膜瓣修复唇裂术后红唇不足

应用颊肌粘膜瓣修复唇裂术后红唇不足庞晓纲田奉宸金惠玲王家盛唇裂术后，特别是单侧唇裂术后，由于两侧红唇组织发育不均衡或术中去除红唇组织不当，随年龄增长常造成一侧红唇厚度过薄畸形，上唇两侧明显不对称。从１９８６年以来，我们应用颊肌粘膜瓣修复此类畸形１４例...     

应用岛状烦肌粘膜瓣修复部分舌缺损

目的:探索一种用相同或相似组织修复舌缺损的方法,介绍岛状颊肌粘膜瓣修复部分舌缺损的经验。方法:应用以面动静脉为蒂的岛状颊肌粘膜瓣修复16例舌癌切除后的部分舌缺损。结果:16例患者术后岛状颊肌粘膜瓣全部完全成活,效果满意。无血肿、感染、腮腺导管损伤、面神经损伤和开口功能障碍等并发症,舌的形态、功能良好。1例半舌切除后的患者术后肌电图显示,颊肌粘膜瓣内的肌肉获得神经再支配且运动良好。结论:面动静脉岛状颊肌粘膜瓣组织学上类似于舌组织,血运丰富,转移灵活,可以获得神经再支配,有重建舌的运动功能的潜能,是修复舌缺损的一个良好选择。     

应用岛状颊肌粘膜瓣修复腭裂初步报告

目的：介绍应用岛状颊肌粘膜瓣修复腭裂的临床实践。方法：应用裂缘葶粘骨膜瓣闭合硬腭裂隙的鼻腔侧、软腭后推、软腭鼻侧粘膜Z成形术延长、腭帆提肌吊带重建,再以蒂在后的血管神经蒂岛状颊肌粘膜瓣修复软腭后推后在腭部遗留的横行创面和硬腭裂隙的口腔侧创面。结果：1997年以来共治疗12例,术后岛状颊肌粘膜瓣完全成活,软腭延长显著,无腭瘘形成,无血肿、感染、肋腺导管和面神经损伤及开口功能障碍等并发症发生。结论：岛状颊肌粘膜瓣血运好,易成活;术后早期不需配戴牙垫,不影响恒磨牙的萌出,不干扰咬合,无埯断蒂,不破坏翼下颌皱襞形态和结构,供区易于缝合,感觉功能好。     

颊肌黏膜瓣在宽大红唇及口轮匝肌缺损修复中的应用

目的探讨修复大面积的红唇及口轮匝肌缺损的手术方法。方法设计以面动脉前颊支为血管蒂的颊肌黏膜瓣,用以修复上或下唇宽大的红唇及口轮匝肌缺损。结果共治疗7例,5例患者术后无任何并发症,2例患者颊肌黏膜瓣尖端黏膜坏死,未累及肌层,术后创面通过黏膜上皮化而愈合,无其他并发症发生。术后早期即可测到温度觉、触觉,肌电图和电镜显示瓣内肌肉有运动神经支配。结论应用颊肌黏膜瓣可以修复用常规方法难以解决的宽大红唇及口轮匝肌缺损,并且可获得良好的形态、感觉和功能。     

应用下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形

目的探讨下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形的临床效果。方法根据红唇缺损量及部位,设计下唇口轮匝肌黏膜瓣的长度和宽度,双侧蒂部切口适当向口角内延伸,红唇复合组织瓣转位修复红唇缺损。结果本组8例患者术后口轮匝肌黏膜瓣血运良好,随访6~12个月,修复红唇饱满对称,口角形态自然,张口不受限,术区瘢痕不明显,上唇外观改善良好,下唇形态良好,无与手术相关的并发症发生。结论采用下唇双蒂口轮匝肌黏膜瓣修复上唇红唇缺损畸形具有手术操作简单,安全性高,切口隐蔽,修复效果好等优点,值得临床推广应用。     

红唇瓣推进修复双侧唇裂继发红唇缺损

目的 介绍一种双侧唇裂术后继发红唇缺损的修复方法。方法 于缺损红唇的两侧红白唇交界处或其稍上方按需要向其两侧各设计红唇瓣，缺损范围大都可将一侧红唇瓣设计至口角下唇处，按设计切开解剖游离以唇动脉为蒂的红唇轴型瓣，向缺损区推进修复缺损。结果 临床应用15例。缺损宽度1.0-1.2cm，所有唇瓣全部成活，术后唇外形满意。结论 以唇动脉为蒂的红唇瓣推进修复红唇缺损，方法简便，唇瓣血供可靠，疗效满意，可广泛用于修复各种原因引起的红唇适当大小的部分缺损。     

无覆盖带蒂颊脂垫瓣在修复口腔缺损中的应用

目的：介绍无覆盖带蒂颊脂垫瓣用于口腔缺损修复的实践。方法：将颊脂垫瓣转移到相应的口腔缺损区,暴露的颊脂垫瓣表面无需植皮,可以自行上皮化。结果：共治疗口腔缺损病例13例,均获成功,颊脂垫瓣封闭效果好。结论：无覆盖带蒂颊脂垫瓣作为局部区域性组织转移瓣,对口腔内颊部、软腭和牙槽等部位软组织缺损的修复尤为适宜,是一种口腔内软组织缺损理想的充填材料。     

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.     

Reconstruction of the vermilion after "lip-shave"

During the year 1986, 12 "lip-shave" defects were reconstructed using orbicularis oris myomucosal flaps, in the Northern Ireland Plastic and Maxillo-Facial Service. Three of these were extended lip-shaves. The planning of a V-Y plasty for myomucusal advancement is described and some representative results are shown. We feel that the myomucosal advancement flap is a valuable technique to overcome some of the problems in reconstruction of the vermilion after lip-shave.     

The evaluation of the use of the buccal myomucosal flap in cleft palate repair—a comparative study

This study aimed to evaluate the importance of using the buccal myomucosal flap in cleft palate repair. This is a retrospective comparative study between two centers in which almost the same technique of cleft palate repair is used. The main difference in the repairs is that a buccal myomucosal flap is used as a part of the operation in one center and not in the other. The patients were divided into two groups. Group A was composed of the cases operated at the Craniofacial Institute in Southfield, MI, USA by the second author. In these, a buccal myomucosal flap was used as a step in the cleft palate repair. Group B contained the cases operated in the Plastic Surgery Department Khoula Hospital, Muscat, Sultanate of Oman using the same procedure but without using the buccal myomucosal flap. The duration of the study was from January 1995 to June 2005. The cases were assessed for oronasal fistulae of the secondary palate. The development of velopharyngeal incompetence (VPI) after a minimum follow-up period of 3 years requiring operative intervention was also assessed in the two groups. In group A (using the buccal myomucosal flap), the incidence of oronasal fistulae of the secondary palate was found to be 2 of 126 patients who underwent cleft palate repair (1.6%). The incidence of VPI requiring pharyngoplasty was found to be six out of 94 patients followed up for a period more than 3 years (6.4%). In two patients, buccal flap division of the pedicle was required because the patient was biting on it. In group B (buccal myomucosal flap not used), the incidence of oronasal fistulae of the secondary palate was 14 out of 299 patients who underwent cleft palate repair (4.6%). The incidence of VPI requiring pharyngoplasty was 36 out of 146 patients followed for a period of more than 3 years (24.7%). The incidence of fistulae and VPI development in both groups was found to be decreasing as experience with the technique increased. The use of the buccal myomucosal flap in cleft palate repair has proven to be an effective tool in the reduction of the incidence of fistula formation and VPI. The flap allows cleft palate repair without tension, and this has decreased the incidence of fistula formation. Adding an additional length to the nasal layer of the palate by using this flap also decreases the incidence of VPI significantly. If the flap needs to be divided, it can be performed as an outpatient procedure.     

邻位粘膜瓣修复邻近唇红处粘膜缺损的疗效观察

目的:观察邻近唇红的唇粘膜侧良性病变切除后邻位瓣修复缺损的临床效果。方法:35例邻近唇红的唇粘膜侧良性病变,沿病变边界稍外侧切除,应用邻位粘膜瓣修复缺损,随访观察术后效果。结果:术后1周所有病例邻位粘膜瓣均一期愈合,唇红部外形无移位、畸形,随访3~12个月,病变未见复发,唇部外观无畸形。结论:唇粘膜邻位组织瓣修复邻近唇红的粘膜缺损,可获得满意美观效果。