One-stage reconstruction of the whole lower lip

One-stage reconstruction of the whole lower lip

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O N E - S T A G E R E C O N S T R U C T I O N OF THE W H O L E LOWER L I P

67

O p e r a t i v e T e c h n i q u e . When the excision has been carried out (Figs. I and 2), submandibular flaps are raised from both sides consisting of skin, subcutaneous tissue and platysma (Fig. 3). There is always superfluous skin in this region of the neck in older patients and the blood supply to the flaps is good. When the flaps are raised access is provided for neck dissection if this is required (Fig. 4). The two flaps are rotated to the

FIG. 4.

F!G. 4 FIG. 5 S u b m a n d i b u l a r flaps of skin, subcutaneous platysma have been raised.

tissue and

FI~. 5. Diagram to show how the skin flaps are rotated into the defect and the mucosal flaps swung downwards to provide lining.

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FIG. 6. FIG. 7.

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FIG. 7 The flaps sutured in position.

Immediate post-operative r e s u l t . . T h e dog-ear may~be removed later if desired.

midline and sutured together (Figs. 5-7). The secondary defects can be closed primarily without noticeable tension. In order to form the lining, flaps of mucosa are taken from the inside of the cheek, rotated medially and sewn to each other and to the lip margin of the skin flaps. The donor areas are closed primarily. Since there is enough skin on the neck one can obtain flaps of any size required and

68

B R I T I S H J O U R N A L OF P L A S T I C SURGERY

thus avoid the unpleasant diagonal tension in the area of the lower lip observed after other methods. It is true that a slight protrusion is formed over the point of the chin but this can easily be removed later.

A

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FIG. 8. A and t3, 3 months after operation, showing adequate skin and mucosal lining.

SIJMMA~Y The use of bilateral submandibular flaps to reconstruct the lower lip and chin region is described. Because of the excess skin in this region in older patients, large flaps are readily obtained, the secondary defect can be closed directly and the incisions are easily combined with those of a neck dissection°