应用双侧红唇瓣推进修复单侧唇裂术后继发红唇畸形.docVIP

应用双侧红唇瓣推进修复单侧唇裂术后继发红唇畸形[摘要]目的:探讨应用双侧红唇瓣推进修复单侧唇裂术后继发红唇畸形的临床效果。方法:切除红唇瘢痕畸形后,沿缺损两侧红白唇交界线切开并游离两侧正常红唇粘膜肌瓣,长度一般为1～2cm,向缺损区推进修复缺损。结果:术后患者唇弓形态完整良好,红唇丰满,手术瘢痕不明显。结论:在适应证选择适当的情况下,应用双侧红唇瓣推进修复单侧唇裂术后继发红唇畸形,方法简便,效果良好。 [关键词]唇裂;外科皮瓣;红唇;手术后并发症 [中图分类号]R782.2+1 [文献标识码]A [文章编号]1008-6455(2010)01-0049-03 Bilateral vermilion flap propelling for repair secondary vermilion deformity of unilateral cleft lip ZHOU Jian-hong,HE Feng-lan,REN Chang-qun (Department of Maxillofacial Surgery,180th Hospital of PLA,Quanzhou 362000,Fujian,China) Abstract:ObjectiveTo evaluate the clinical effect of bilateral vermilion flap propelling for repair secondary vermilion deformity of unilateral cleft lip.Methods After excision of the scar of vermilion,bilateral mucosa-muscle flaps of normal vermilion in length of 1～2mm beside the defect were cut along the vemilion boundary and then were propelled to repair the defective region.ResultsThe postoperative appearance of the cubit’s bow was integrity and fine. The shape of the prolabium was fullnessly and the scar was minimal. ConclusionIf the indication was appropriate,the method of Bilateral vermilion flap propelling for repair secondary vermilion deformity of unilateral cleft lip is simple and can obertain fine result. Key words:cleft lip;surgical flap;vermilion;complication 在单侧唇裂的一期整复中,由于红唇解剖结构的复杂性和现有唇裂整复方法处理红唇的相对简单,导致术后遗留很多的继发红唇畸形,对其再次整复是临床面临的难题。2005年以来我科应用双侧红唇瓣推进修复单侧唇裂术后继发红唇畸形,取得了较满意的效果。现报道如下。 1资料和方法 1.1临床资料:选择2005年1月～2007年12月行单侧唇裂术后继发红唇畸形需二期整复患者41例(男22例,女19例),左侧18例,右侧23例,年龄12～21岁。病例选择标准:术前测量人中切迹点到两侧口角点的红唇长度,选择患侧红唇长度大于或等于健侧红唇长度的病例行双侧红唇瓣推进整复术。 1.2手术方法:双侧眶下神经阻滞麻醉或全身麻醉下,根据患者单侧唇裂术后继发畸形的不同情况处理白唇畸形,一般尽量按原切口切开(如图1),切除瘢痕,在原切口的两侧皮下分离口轮匝肌并行功能性口轮匝肌修复术,皮肤缺损按改良Millard术式、Z改形术或者直线缝合处理(如图2～3)。对于红唇畸形,则将红唇畸形处表浅瘢痕组织和过高的唇峰切除,保留基底部口轮匝肌,然后沿缺损两侧红白唇交界线分别设计切口线,长度一般为1～2cm,红唇下缘一般不切开,切取并游离两侧正常红唇瓣(如图4),红唇瓣切取厚度视缺损深度而定,一般需带有一定厚度口轮匝肌,观察红唇瓣张力情况,如张力较大可延长切口,但注意保持人中切迹于中线位置,尽量避免损伤唇动脉,将两侧红唇瓣向缺损推进拉拢,缝合前将两侧红唇瓣口轮匝肌层与粘膜层用小圆刀锐性分离1～2mm,先缝合口轮匝肌层,再缝合红唇粘膜层关闭缺损,缝合口轮匝肌层时注意缝合较紧