Correcting the secondary bilateral cleft lip deformities using an innovative partial-thickness musculomucosal pedicle cross-lip flap / 中华医学美学美容杂志

Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip.We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap.Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities.The central defects usually occurred in these patients.The defects were reconstructed partially or completely according to the severities of the defects.The operative procedures were as follows: The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided.Then the partial-thickness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect.Results All 98 musculomucosal pedicle flaps were viable.The upper lips were reconstructed according to the severities.Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity.It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities.

Fechamento de fístula oronasal com retalho miomucoso labial superior / Closure of an oronasal fistula with a myomucosal upper lip flap

INTRODUÇÃO: A fístula palatina é a complicação mais frequente após palatoplastias e sua presença traz diversas implicações. Sua apresentação é diversificada e seu reparo pode ser difícil, o que se traduz na existência de uma diversidade de técnicas cirúrgicas descritas. OBJETIVO: Relatar a correção cirúrgica de fístula palatina anterior com retalho miomucoso labial superior, além de fazer uma breve revisão da literatura. RELATO DE CASO: Paciente submetido à correção de fissura palatina completa, apresentando, no pós-operatório mediato, fístula anterior de palato duro e processo alveolar, submetido à correção da fístula palatina oronasal com retalho miomucoso de lábio superior. O paciente evoluiu satisfatoriamente, sem complicações e sem recidiva da lesão após um ano de seguimento. CONCLUSÃO: A técnica em questão mostrou-se simples e eficiente, prestando-se à correção da fístula palatal anterior.

INTRODUCTION: Palatal fistula is the most common complication after palatoplasty, and its presence entails various implications. Its presentation is diverse and repair can be difficult, which is reflected in the existence of a numerous surgical techniques described for its treatment. OBJECTIVE: To report the surgical correction of palatal fistula with a myomucosal upper lip flap, along with a brief review of the literature. CASE REPORT: The patient underwent repair of complete cleft palate. At the immediate postoperative time, an anterior fistula of the hard palate and alveolar process was present and was subjected to a correction with an oronasal myomucosal upper lip flap. The patient progressed satisfactorily, without complications or lesion recurrence after 1 year of follow-up. CONCLUSION: The technique presented is a simple and efficient method for correction of an anterior palatal fistula.

Clinical application of lower cross-lip flap in treatment of upper lip defect / 中华医学美学美容杂志

Objective To evaluate the clinical effect of the upper lip defect with lower cross-lip flap (Abbe-Estlander flap).Methods A total of 68 cases of upper lip defect underwent the reconstruction with cross-lip flaps.We applied Abbe flap in upper lip defect in the center,and Estlander flap in lateral upper lip defect.This method was a two-stage procedure:the first stage was to rotate flap 180 degrees into the upper lip defect and to suture with the created defect of the upper lip,with careful maintenance of blood supply from the pedicle; the second was to undertake the division of bridged pedicle and paid more attention to creation of the vermilion border.Results The flaps survived in all cases.Evaluation from 3 to 12 months after the operation showed that the shape of lips were obviously repaired with excellent aesthetic and functional results.Conclusions Abbe-Estlander flap could reconstruct anatomical features and function of the lip precisely.It seems that within certain limits (probably between one-third and one-half of total upper lip length),this flap appears to be the preferred method for upper lip reconstruction.

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.