摘要
唇肿瘤手术可能导致唇和唇周缺损,目前缺乏明确的唇肿瘤切除术后唇和唇周区域缺损分类分型与缺损修复重建原则.笔者根据唇缺损的范围将唇缺损分为唇部分缺损、唇全层缺损和唇全层伴唇周缺损3大类.其中唇部分缺损包括红唇缺损、唇皮肤缺损、唇黏膜缺损和唇洞穿缺损4型;唇全层缺损包括小半唇、半唇、次全唇缺损和全唇缺损4型;唇全层伴唇周缺损包括口角颊洞穿性缺损、全唇颏缺损和全唇鼻缺损3型.唇肿瘤根治性手术的同时,唇和唇周区域不同类型缺损原则上是同期修复的.缺损修复方法包括一期缝合、皮肤或黏膜移植、局部皮瓣、区域皮瓣、带蒂皮瓣、游离皮瓣和同种异体真皮基质修复等方法;也可以结合多个组织瓣进行修复重建.其中,腹侧舌肌黏膜瓣是修复重建红唇缺损的理想组织瓣;Abbe-Estlander瓣是唇缺损修复重建非常重要的技术;双侧颏神经血管V-Y岛状推进皮瓣与舌黏膜瓣联合重建全下唇缺损,方法可靠效果好;修复唇口角颊洞穿性缺损可选用Estlander瓣,折叠延长锁骨上岛状皮瓣或折叠面-颏下动脉岛状瓣;全唇颏或全唇鼻缺损等特大型缺损需要用胸大肌瓣,斜方肌肌皮瓣或游离组织瓣甚至联合多瓣进行修复.本文提出了唇肿瘤术后唇及唇周缺损的分类和分型,较系统地阐述了唇及唇周缺损功能修复重建的方法,对临床具有一定的指导和推广应用价值.
Abstract
Defects in the lip and perilabial regions can be caused by lip oncosurgery.Currently,there is a lack of clear classification and principles for repairing and reconstructing the lip and perilabial defects after lip tumor resection surgery.Lip defects are categorized into three types based on their extent by author:partial lip defects,full-thickness lip defects,and full-thickness lip defects with surrounding lip defects.The partial lip defects include four types:labial vermilion defects,labial cutaneous defects,labial mucosal defects,and through-and-through labial defects.There are four types of full-thickness lip defects,including less than half of labial defects,one half of labial defects,subtotal labial defects,and total labial defects.There are three types of full-thickness lip defects with surrounding lip defects,including through-and-through commissure and cheek defects,total labial and nasal defects,and total labial and chin defects.Different types of defects in the lip and perilabial region should be repaired during radical surgery for lip tumors.The methods of repair and reconstruction of lip and perilabial defects include primary closure,skin or mucosal grafting,local flaps,regional flaps,pedicle flaps,free flaps,and allogeneic dermal matrix(ADM).Multiple tissue flaps can also be combined for repair and reconstruction.Among them,the anteriorly based ventral tongue flap is an ideal tissue flap for repairing and recon-structing labial vermilion defects.The Abbe-Estlander flap is a very important technique for repairing and reconstructing lip de-fects.The combination of bilateral mental neurovascular V-Y island advancement flap and an anteriorly based ventral tongue flap for reconstruction of the total lower lip defect is a reliable and effective method.The Estlander flap,foldable supraclavicular fascio-cutaneous island flap,or foldable facial-submental artery island flap can be used to repair the through-and-through labial commis-sure and cheek defects.Large perilabial defects such as total labial and chin defects or total labial and nasal defects require repair using pectoralis major muscle flaps,trapezius muscle flaps,free tissue flaps,or even a combination of multiple flaps.This article proposes the classification of lip and perilabial defects following oncosurgery and systematically elaborates on the functional repair and reconstruction of the defects,which has certain guiding and promotional application value for clinical practice.
维普
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