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。     

局部带蒂皮瓣在唇部外伤性缺损即刻修复中的应用

目的:介绍局部带蒂皮瓣在唇部外伤性缺损即刻修复中的临床应用。方法:2006年5月～2011年4月,对21例外伤性唇缺损畸形患者,采用局部带蒂皮瓣进行了即刻修复者,进行临床效果观察和总结分析。结果:应用局部带蒂皮瓣,对21例唇部外伤性缺损患者,根据其不同部位和程度,分别采用了鼻唇沟皮瓣、局部推进皮瓣"、Z"形交叉皮瓣或唇红粘膜瓣、舌瓣等邻近带蒂皮瓣进行即刻修复,唇部外形恢复良好,治疗效果满意。结论:对外伤性唇缺损采用局部带蒂皮瓣进行即刻修复,因其血供良好,易取材方便、方法灵活,易于掌握,多数可一次成功,值得临床推广。     

局部皮瓣在唇缺损修复中的应用

目的：探讨局部皮瓣在唇缺损修复中的应用及效果。方法：本组共31例各种原因所致唇缺损病例,根据缺损的程度及部位,分别应用不同的局部皮瓣进行修复。唇缺损范围≤1/3唇长,行直接拉拢缝合并Z改形术;唇缺损范围1/3～1/2,应用唇复合组织瓣或对侧唇交叉瓣修复;下唇缺损范围1/2～2/3,应用同侧唇颊部旋转皮瓣修复。结果：所有病例皮瓣全部成活,唇部外观明显改善,效果满意。2例下唇缺损范围1/2～2/3者修复后患侧红唇组织厚度不足,其余病例上下唇比例基本协调,局部组织无明显畸形,术后功能良好。随访2月～4年,唇部外观无明显变形及功能障碍,无复发及死亡病例。结论：对于唇缺损的修复,应根据缺损的程度及部位等具体情况选择正确的局部皮瓣以利于恢复唇部的良好形态及功能。     

唇红肌粘膜瓣修复外伤性部分唇红缺损5例报告

我科近年来对5例外伤性部分唇红缺损的伤员应用唇红肌粘膜瓣进行一期修复取得了满意的效果,现报告如下。一、临床资料本组5例均为男性、年龄20～35岁。3例交通事故、1例咬伤。1例跌伤。上唇正中部唇红缺损2例。下唇唇红缺损3例。面积为1.0ｃｍ×1.5ｃｍ。手术方法:在唇红缺损处沿唇红缘向两侧口角作松弛切口,切开皮肤和唇红粘膜后斜向唇粘膜方向,带一部分肌肉直达唇粘膜并将唇动脉包含在切取的肌肉粘膜瓣内,形成两个以口角部为蒂的唇红肌粘膜瓣,两瓣向缺损区滑行推进并关闭创面,如张力大可将蒂部向口角处延伸,勿超过口角。上唇正中缺损可将…     

唇红肌肉粘膜瓣修复单侧唇红缺损畸形

目的：介绍一种简单有效修复一侧唇红缺损的方法。方法：笔者利用健侧唇红肌肉粘膜瓣修复7例单侧唇红缺损畸形。结果：修复后患唇获得一个相对对称而自然的外观,医患双方均对手术效果满意。结论：唇红肌肉粘膜瓣修复单侧唇红缺损效果确切,值得临床推广。     

联合应用皮瓣移植与扩张皮瓣修复唇颊部全层组织缺损

目的：探讨唇部全层复合组织缺损的修复治疗方法。方法：根据缺损的部位、层次、大小等，分别采用下颌部面动脉逆行岛状皮瓣，胸锁乳突肌皮瓣，颞浅动脉额支岛状皮瓣，耳后岛状皮瓣瓦合以扩张皮瓣进行修复。结果：17例唇颊部全层缺损患者分别应用皮瓣移植加扩张皮瓣转移修复治疗，所有皮瓣全部成活，外形及功能满意，经半年至5年随访未见并发症发生，效果良好。结论：唇颊部复合组织缺损手术方法要依病情合理选择，小的缺损可以应用局部组织瓣转移修复，本方法适用于局部组织瓣转移难以修复的较大唇颊部全层组织缺损，修复后唇颊丰满度适中，皮肤色泽纹理接近正常，形态满意。     

下唇交叉粘膜瓣修复外伤性上唇唇红缺损

目的：探讨针对外伤性上唇唇红部分缺损畸形的修复方法。方法：应用下唇交叉粘膜瓣，分两次手术修复上唇部分唇红缺损，唇红瓣面积最小为1．8cm×1．0cm，最大为3．0cm×2．0cm。结果：自2002年3月以来，应用下唇交叉粘膜瓣修复外伤性上唇唇红部分缺损患者共10例，粘膜瓣全部成活良好，术后外观满意。结论：应用下唇交叉粘膜瓣修复外伤性上唇唇红部分缺损畸形，具有较强的临床适应证。     

下唇动脉岛状皮瓣修复上唇缺损

目的 探讨下唇动脉岛状皮瓣修复上唇缺损的可行性及效果.方法 采用单侧下唇动脉岛状皮瓣修复上唇唇红及白唇局部缺损,皮瓣蒂部包括1条下唇动脉和2条下唇静脉.自2005年7月至2011年5月,共修复上唇缺损患者7例.结果 本组7例患者,术后随访3～6个月,皮瓣全部成活,颜色、质地与周围皮肤相近,无明显的挛缩,皮瓣感觉功能良好,水从口中漏出明显改善,无口轮匝肌功能障碍,患者对上唇功能及外观都满意.其中,3例患者于术后3个月行唇弓、唇珠、人中成形术.结论 应用单侧下唇动脉岛状皮瓣修复上唇唇红联合白唇局部缺损是一种比较理想的方法.     

以双蒂下唇动脉岛状唇瓣行上唇唇红增厚术

目的总结应用双蒂下唇动脉岛状唇红瓣修复上唇过薄畸形的手术经验。方法1997年3月~2005年3月治疗上唇过薄畸形7例,男2例,女5例。年龄16~23岁。其中先天性双侧唇裂术后继发畸形5例,唇部血管瘤同位素治疗后继发唇萎缩2例。岛状唇瓣长度相当于整个下唇,最宽处为0.5~0.8cm。于下唇制作以双侧下唇动脉为营养血管蒂的岛状唇红瓣,移位修复上唇唇红组织缺损。其中5例于术后3~6个月后再次行唇弓、唇珠、人中等成形或改形术。结果术后唇瓣全部成活,伤口期愈合,7d拆线。随访1~3年,上唇唇红丰满,唇瓣色泽良好,美容标志明显;下唇瘢痕不明显,功能不受影响。上下唇协调、美观。结论双蒂下唇动脉岛状皮瓣修复上唇唇红组织缺损,设计合理,实用性强,效果可靠,值得推广应用。     

改良Matsuo＇s法矫正口哨唇畸形临床应用

目的：探讨唇裂术后继发口哨唇畸形的治疗方法。方法：在Matsuo＇s法基础上改进缺损二侧唇粘膜瓣转移矫正红唇部的缺损,同时还可以减缓上唇的张力、加深唇龈沟。结果：采用改良的Matsuo＇s法治疗口哨唇75例,组织瓣成活良好,均获得满意的唇部形态。结论：改良的Matsuo＇s法简便易行、术后效果稳定,是Ⅰ度、Ⅱ度口哨唇畸形矫治的良好方法。     

Rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps-an experimental study in the rat inguinal skin

PURPOSE: To investigate the rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps. MATERIALS AND METHODS: Lower extremities of 20 male Sprague-Dawley rats were strained and fixed on a table to provide a tension line over the inguinal area. Two rhomboid shaped adjacent flaps with subcutaneous pedicles were designed over the tension line. Each flap was 1cm long and the distance between two flaps was 0.5 cm. The total pre-operative length was 2.5 cm. Flaps were incised and freed from the stretched skin. Tension line over the inguinal area was relieved by relaxation incisions. The resulting defects were then closed by suturing the rhomboid flaps in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final elongation was measured and the results were analysed statistically. RESULTS: All relaxation incisions were effective in relief of tension over the inguinal area and in lengthening the tension line. Pre-operative 2.5 cm lengths ranged between 5.7 and 6.3 cm post-operatively (mean +/- standard deviation = 5.99 +/- 17 cm). The mean difference between pre- and post-operative measurements was 3.49 cm (139.6% gain in length). The subcutaneous pedicle rhomboid flaps easily closed all defects generated by relaxation and elongation. Statistical analysis revealed that two adjacent subcutaneous pedicle rhomboid flaps were efficient to close the defects generated by the relaxation incisions that produced a 139% gain in length (P < 0.001). CONCLUSION: The results of this experimental study show that multiple subcutaneous pedicle rhomboid flaps promise to be a good alternate technique in the treatment of long contracture bands in terms of rate of elongation and simplicity.     

One-stage reconstruction of a large defect of the lower lip and oral commissure.

Large lower lip defects including the oral commissure are very difficult to reconstruct and obtain an aesthetic appearance and an acceptable function. We report two patients who had a large defect in the lower lip including oral commissure and were treated using free radial forearm flap and temporal muscle transfer in one-stage. For the cutaneous defects, in one a local flap was elevated from the adjacent cheek and in the other a turned over area of the forearm flap was used. In each case, the reconstructed lower lip could maintain adequate elevation of oral the commissure using the temporal muscle was worked. The first case which used a local flap externally could avoid sialorrhea and had good sensation, and could close the mouth firmly soon after surgery. The appearance was acceptable. In the other case, leakage of oral contact and air occurred at the oral commissure because of the thickness of the forearm flap but improved after minor correction some 8 months after the surgery.     

指端部分缺损的形态学修复

目的 研究应用吻合血管的游离足趾组织移植急诊修复拇指及其他手指指端部分缺损的治疗方法.方法 对19例21指指端部分缺损者,应用趾趾腹皮瓣、第2趾趾腹皮瓣、第2趾趾甲皮瓣、跗趾半侧趾甲皮瓣、第2趾半侧趾甲皮瓣游离移植进行再造.结果 19例21指游离皮瓣、趾甲皮瓣全部成活,术后经过3～6个月的随访,患指指腹饱满并具有指纹,外观良好,两点分辨觉为4～6 mm.结论 对于手指指端部分缺损,应用上述手术方法进行再造,可达到良好的修复效果.     

鼻唇沟皮下组织蒂皮瓣在上唇缺损修复中的应用

目的：介绍鼻唇沟皮下组织蒂皮瓣在上唇缺损修复中的应用。方法：2006年6月～2010年4月间,应用鼻唇沟皮下组织蒂皮瓣修复上唇缺损31例。于缺损邻近部位设计鼻唇沟皮下组织蒂皮瓣,按设计线切开皮肤,向下及周围潜行分离形成皮瓣,滑行或旋转修复上唇缺损。结果：应用此法修复上唇缺损31例,切口均I期愈合,皮瓣全部成活,术区平整,无＂猫耳＂畸形,面部形态满意,远期瘢痕不明显。结论：鼻唇沟皮下组织蒂皮瓣修复上唇缺损,手术效果肯定,能达到良好的美学效果,是一种较理想的修复方法。     

Reconstruction of medium-sized defects of oral commissure by combining double full-thickness cheek rhomboidal flaps and a small lip switch flap

Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. The methods described by using either a cross lip flap or a flap from the adjacent cheek skin and mucosa may not be able to achieve such goals if each method is used on its own. We have combined double full-thickness cheek rhomboidal flaps with a small lip switch flap from the remaining lip segment to reconstruct medium-sized full-thickness defects of the oral commissure, following tumor excision in 7 patients. The functional and aesthetic outcomes were assessed by the evaluation of 3 parameters under each category. Each parameter received a score of good, moderate, or poor. Six patients had a good overall functional score. Microstomia was noted only in 1 patient. The overall aesthetic score for all the 7 patients was moderate. In conclusion, reconstruction of medium-sized commissural defects by the present technique achieves adequate oral competence and a satisfactory cosmetic result.     

股前外侧皮瓣与筋膜组织瓣的临床应用

目的探讨股前外侧皮瓣与筋膜组织瓣的临床应用方式。方法1997年1月~2004年7月,应用股前外侧皮瓣与筋膜组织瓣修复体表皮肤软组织缺损27例,男10例,女17例。其中缺损位于面部9例,颈部4例,下肢6例,会阴部4例,臀部1例,腹股沟区1例,乳房软组织缺损2例。所有患者均为择期手术,软组织缺损范围9cm×8cm~20cm×15cm,切取皮瓣范围10cm×8cm~33cm×15cm。结果术后26例皮瓣全部成活,创面期愈合,1例皮瓣坏死,创面经换药、再次手术植皮后愈合。17例移位皮瓣外观良好,质地柔软,有感觉;9例略显臃肿,经二次手术修薄外观较好。23例获随访3个月~2年,受区皮瓣颜色、质地、感觉与周围组织接近,供区局部凹陷畸形不明显;其中6例肿瘤患者获随访6~15个月,肿瘤局部无复发。结论股前外侧皮瓣与筋膜组织瓣能提供充足的皮肤软组织量,且可采用多种应用方式,是修复大面积体表皮肤软组织缺损的理想皮瓣。     

Lip reconstruction in noma sequelae

Noma is a grangenous stomatitis which might extend to other facial structures leading to extensive soft tissue and bony defects. Reconstruction of noma sequellae should take into account a few principles in relation to the particular aspect of this disease: (1) correction of the mandibular constriction; (2) removal of scar tissue in order to recreate the initial defect; (3) reconstruction of the missing bony framework; (4) reconstruction of the maxilla and upper lip before building the nose in case it is destroyed; (5) anticipation of the facial growth. Reconstruction of the lips, in case of extensive defects often necessitates a distant skin flap. As free flaps, the forearm fascio-cutaneous flap or the serratus musculo-cutaneous flap were used according to the size of the defect. The mucosal part of the lip is usually reconstructed with a local flap from the adjacent lip or an heterolabial flap (Estlander flap).     

Bilateral Vermilion Rotation Flap

BACKGROUND: Principles of aesthetic reconstruction recommend repair within cosmetic units with tissue of similar color, texture, and thickness. Because of the central facial location and primary functional and aesthetic importance of the lips, successful repair is critical in this location. Numerous procedures to reconstruct the lip have been reported; however, many result in a significant decrease in the oral aperture as well as dysesthesias, limitation of mobility, and significant scarring. OBJECTIVE: The purpose of this study was to describe a reconstructive option that repairs with skin of similar characteristics and avoids crossing into adjacent cosmetic subunits or sacrifice of normal skin or muscle. The proposed procedure is able to repair surgical defects up to 40% of the vermilion width in one stage and minimize the risk of nerve damage, scarring, or functional impairment. METHODS: The bilateral vermilion rotation flap permits repair within cosmetic subunits, repairs with skin of identical surface characteristics, and avoids surgery to the adjacent cutaneous or muscular portions of the lip. By keeping the pedicle intact, injury to neurovascular structures is minimized. RESULTS: The procedure provides an excellent repair for selected defects of the vermilion lip by following guidelines for optimum aesthetic and functional repair (i.e., repair within cosmetic subunits using skin of identical characteristics while avoiding trauma to the uninvolved cutaneous lip or orbicularis oris). CONCLUSION: The bilateral vermilion rotation flap is a useful technique for repair of surgical defects on the vermilion lip. It avoids unnecessary sacrifice of cutaneous or muscular lip tissue and provides an excellent cosmetic and functional result.     

The step technique for the reconstruction of lower lip defects after cancer resection. A follow-up study of 165 cases

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.     

应用上唇外侧组织瓣旋转修复下唇缺损

目的:探求上唇外侧组织瓣在修复较大面积下唇缺损中的作用。方法:根据患者下唇缺损情况,设计上唇外侧组织瓣,旋转后插入缺损组织,同时在缺损吻合处,将上层外侧旋转瓣内侧粘膜肌肉向外牵拉形成部分新的红唇,然后逐层相对缝合,修复缺损。结果:自2003年1月应用此方法修复患者6例,术后随访1～2年,唇部外形好,无流涎,无口闭合不全,效果满意。