改良拱顶石皮瓣在上唇缺损修复中的应用
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摘要
目的探讨改良拱顶石皮瓣在上唇缺损修复中的应用价值。方法切除肿瘤后的外侧切缘为皮瓣内侧边,平行鼻唇沟方向设计拱顶石皮瓣外侧边,皮瓣外侧边至鼻唇沟的距离与缺损创面的最大直径一致,鼻翼沟向外上延伸与外侧边相交形成一上底角,唇缘向外下延伸与外侧边相交形成下底角,进而形成一岛状皮瓣,对皮瓣进行分离推进转移至创面,分层间断缝合。结果本组13例患者随访8～24个月,未出现并发症,无再次手术病例。结论上唇拱顶石皮瓣血供良好,手术安全,瘢痕隐蔽,美容效果良好,修复效果满意。
Objective To explore the application of improved keystone flap in the reconstruction of upper lip defects. Methods After resection of neoplasm, the lateral margin of the defect was the medial border of the keystone flap. The lateral border of the keystone flap was designed in a direction parallel to the nasolabial groove. The distance from the lateral border of the flap to the nasolabial groove was the same as the maximum diameter of the defect. The sulcus alaris was extended outward and upward and then intersected with the lateral border of the flap to form an upper base angle. The lip edge extended outwardly and downwardly and then intersected with the lateral border of the flap to form a lower base angle. Thus, an island flap formed. The improved keystone flap was separated, advanced, and transfered to the wound. Intermittent layer-layer suture was performed. Results All 13 patients were followed up from 8 to 24 months. No complications occurred, and no secondary operation was required. Conclusion There is good blood supply in the improved keystone flap employed in the reconstruction of the upper lip. The operation was safe and the scar was concealable. The cosmetic result was good and the reconstructive effect was satisfactory.
Objective To explore the application of improved keystone flap in the reconstruction of upper lip defects. Methods After resection of neoplasm, the lateral margin of the defect was the medial border of the keystone flap. The lateral border of the keystone flap was designed in a direction parallel to the nasolabial groove. The distance from the lateral border of the flap to the nasolabial groove was the same as the maximum diameter of the defect. The sulcus alaris was extended outward and upward and then intersected with the lateral border of the flap to form an upper base angle. The lip edge extended outwardly and downwardly and then intersected with the lateral border of the flap to form a lower base angle. Thus, an island flap formed. The improved keystone flap was separated, advanced, and transfered to the wound. Intermittent layer-layer suture was performed. Results All 13 patients were followed up from 8 to 24 months. No complications occurred, and no secondary operation was required. Conclusion There is good blood supply in the improved keystone flap employed in the reconstruction of the upper lip. The operation was safe and the scar was concealable. The cosmetic result was good and the reconstructive effect was satisfactory.
引文
[1]武净净,林泉,郑杰,等.鼻唇沟皮瓣联合口轮匝肌瓣修复上唇全层缺损一例[J].中国修复重建外科杂志, 2018,(2):256-256.
[2] BURGET G C, MENICK F J. Aesthetic restoration of one-half the upper lip[J]. Plast Reconstr Surg, 1986,78(5):583-593.
[3] NELIGAN P C. Strategies in lip reconstruction[J]. Clin Plast Surg,2009,36(3):477-485.
[4] WILSON-NAGRANI C, RICHMOND S, PATERNOSTER L.Non-syndromic cleft lip and palate polymorphisms affect normal lip morphology[J]. Front Genet, 2018,9:413.
[5] ISHII L E, BYRNE P J. Lip reconstruction[J]. Facial Plast Surg Clin North Am, 2009,17(3):445-453.
[6]敖胤杰,章宏伟.亚单位原则设计鼻唇沟皮瓣修复上唇缺损一例报道[J].中国美容整形外科杂志, 2017,28(4):251-252.
[7] BEHAN F C. The keystone design perforator island flap in reconstructive surgery[J]. ANZ J Surg, 2003,73(3):112-120.
[8]方硕,杨超,邢新.拱顶石穿支岛状皮瓣[J].中华整形外科杂志,2013,29(6):472-476.
[9]杨超,邢新,徐建国,等.拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用[J].中华整形外科杂志, 2014,30(1):10-13.
[10] LUCE E A. Upper lip reconstruction[J]. Plast Reconstr Surg, 2017Jul 12.
[11]仲维剑,王宏青,张奎启,等.鼻唇部血液供应的应用解剖学研究[J].口腔医学研究, 2002,18(2):124-126.
[2] BURGET G C, MENICK F J. Aesthetic restoration of one-half the upper lip[J]. Plast Reconstr Surg, 1986,78(5):583-593.
[3] NELIGAN P C. Strategies in lip reconstruction[J]. Clin Plast Surg,2009,36(3):477-485.
[4] WILSON-NAGRANI C, RICHMOND S, PATERNOSTER L.Non-syndromic cleft lip and palate polymorphisms affect normal lip morphology[J]. Front Genet, 2018,9:413.
[5] ISHII L E, BYRNE P J. Lip reconstruction[J]. Facial Plast Surg Clin North Am, 2009,17(3):445-453.
[6]敖胤杰,章宏伟.亚单位原则设计鼻唇沟皮瓣修复上唇缺损一例报道[J].中国美容整形外科杂志, 2017,28(4):251-252.
[7] BEHAN F C. The keystone design perforator island flap in reconstructive surgery[J]. ANZ J Surg, 2003,73(3):112-120.
[8]方硕,杨超,邢新.拱顶石穿支岛状皮瓣[J].中华整形外科杂志,2013,29(6):472-476.
[9]杨超,邢新,徐建国,等.拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用[J].中华整形外科杂志, 2014,30(1):10-13.
[10] LUCE E A. Upper lip reconstruction[J]. Plast Reconstr Surg, 2017Jul 12.
[11]仲维剑,王宏青,张奎启,等.鼻唇部血液供应的应用解剖学研究[J].口腔医学研究, 2002,18(2):124-126.