唇红瓣及口轮匝肌功能性修复在先天性单侧唇裂整复中的应用

目的 在Millard法设计的基础上加以改进,利用唇红瓣及口轮匝肌功能性修复,探讨唇红瓣及口轮匝肌功能性修复在先天性单侧唇裂整复中的应用。 方法 2010年9月-2015年12月,对76例先天性单侧唇裂患儿采用口轮匝肌脱套式解剖、功能性修复、鼻孔基底重建及唇红瓣修复唇的方法进行整复。在上唇组织上用Millard法设计,改变"4""7"定点方法,灵活运用,有效地下降患唇的高度,达到上唇组织的解剖性复位。红唇处修复引用Noordhooff的"红线"概念,用唇红瓣相嵌,使唇红整齐,外形饱满;功能上利用口轮匝肌脱套式解剖,重新构建鼻底及上唇口轮匝肌的连续性,以期达到功能性恢复。 结果 76例患儿均一期愈合。术后随访57例,随访时间3个月~2年6个月。54例患儿于静态时,上唇形态恢复满意,唇线对合整齐,两侧唇峰等高、对称,唇珠饱满,患侧人中嵴明显,且与健侧相对应,上唇疤痕不明显。动态时,无明显因肌肉运动而出现的上唇的牵拉、变形以及局部凹陷。3例出现上唇疤痕增生,局部皮肤稍红、硬,略凸出皮肤表面,患侧唇高略短于健侧,在动态时出现患侧红唇的轻度凹陷。 结论 改进的Millard法可有效地降低患唇,合并使用唇红瓣和口轮匝肌功能性修复,使先天性单侧唇裂的整复无论在解剖上还是功能上均达到满意效果,并且设计简单、灵活,值得推广。 

Application of vermilion flap and functional reposition of orbicularis oris in reconstruction of unilateral cleft lip

Objective To investigate the clinical effect of vermilion flap and functional repair of orbicularis oris in reconstruction of unilateral cleft lip by using the vermilion flap and functional reposition of orbicularis oris based on the design of Millard technique. Methods From September,2010 to December,2015,76 cases of congenital unilateral cleft lip underwent orbicularis oris degloving anatomy,functional reposition,reconstruction of nasal basal and muscle remodeling,and vermilion flap.For the upper lip,Millard technique was conducted on flexible use of the"4","7" fixed point method to effectively decrease the height of the affected lip,and to reset the anatomy of the upper lip tissue;For vermilion zone,the vermilion-mucosal junction (red line) of Noordhoff technique was used to embed and align vermilion flap and obtain a plump appearance;For function repair,orbicularis oris muscle degloving anatomical technique was used to reconstruct nasal basal and upper lip orbicularis oculi muscle,thus to achieve functional recovery. Results All 76 patients were achieved primary healing.Fifty-seven cases were followed up for 3 months to 30 months.Fifty-four cases at static state were with satisfactory upper lip shape,neat lip to lip,aligned and symmetrical peaks on both sides,plump lip beads,obvious philtrum ridge in the affected lip and aligned with the normal side,not obvious scar in upper lip;At the dynamic state,without obvious ectopic stretch,deformation and local depression formation in upper lip due to muscular movement.Three cases were with upper lip scar hyperplasia,slightly local skin red and hard,slightly protruding the surface of the skin,the repaired lip slightly shorter than the contralateral lip,ipsilateral lips appear sunken at the dynamic state. Conclusion The modified Millard technique can effectively reduce the upper lip,when combined with vermilion flap and orbicularis oris functional reconstruction,a satisfactory repair for congenital unilateral cleft lip can be obtained both in anatomy and function.The design is simple and flexible,which is worthy of promoting in clinic.