1. Materials and methods
1. 1
From 1983 to 1999, 32 patients with lip defect were treated with this method. Male 18, female 14. The age is 63 years old, the youngest is 14 years old, with an average of 34 years old; Among the 32 patients with lip defect, 16 cases showed that the upper lip was too tight and too short after bilateral cleft lip operation, 8 cases were deformed after unilateral cleft lip operation, 2 cases were deformed after sclerosing agent treatment of hemangioma of the upper lip, 1 case was infected deformity after upper lip injury, and 5 cases were repaired immediately after resection of malignant tumor of the upper lip.
1.2 surgical treatment
1.2. 1 indications: the red lip and part of the white lip in the center of the upper and lower lips are defective, and the defect does not exceed the lip length 1/2.
1.2.2 contraindications ① the defect is greater than the lip length 1/2. ② This method is not suitable for patients who can't tolerate Sawaguchi fissure and can't open it for various reasons 2-3 weeks after operation, such as chronic bronchitis.
1.2.3 Operation Steps The operation is carried out in two stages.
The first operation: (1) design: according to half of the actual width of the upper lip defect, a triangular or W-shaped tissue flap was designed in the middle of the lower lip. In order to rotate 180 upward, a red lip must be cut off, but a red lip must be kept as a pedicle. (2) Incision: Hold the red edges of both lips and make a sharp incision according to Meilan line. First, cut one lip and full-thickness tissue, and the other side to the junction of skin and lip, taking care not to damage the labial artery. The position of the labial artery is on the mucosal side of the labial margin. (3) Hemostasis: Ligate one labial artery and clamp other bleeding places to stop bleeding, but do not ligate. (4) Suture: firstly, the mucosa, muscle and skin of the donor site were sutured in layers, and then the triangular flap was twisted upward, embedded in the defect and sutured in layers.
The second operation: it is feasible to cut off the pedicle about 14 days after operation, but in order to promote blood supply, the pedicle can be trained with rubber bands about 10 days. After training, if the tissue flap can quickly restore blood supply after a short period of pallor, which proves that its collateral circulation has been established, the pedicle can be cut off in advance. When the pedicle is broken, use a sharp knife to cut it obliquely from the outside of the pedicle, put the whole lower lip on the defect of the upper lip, repair the suture scar, inlay and sew to obtain the complete red lip edge, and finally sew the wound edge of the lower lip. In addition, the upper lip flap can also be used to repair the defect of lower lip. The design principle is the same as before, except that the donor lip flap should be designed on both sides of the central area of the upper lip, and the damage to the upper lip notch and lip bead after flap resection should be avoided.
1.2.4 postoperative care (1) between the first operation and the second operation, two small openings are made in the corners on both sides, and thick rubber tubes can be placed to facilitate breathing and eating. (2) 3 days after the first operation, the head bandage was used to limit involuntary mouth opening. (3) Nursing care of the lip wound after cleft lip surgery, that is, scrubbing the wound with boric acid alcohol 2-3 times a day. (4) Antibiotics prevent infection and ephedrine nasal drops protect nasal cavity. (5) Encourage coughing and expectoration to prevent lung infection or atelectasis. (6) Take out stitches after 5 ~ 7 days.
2. Results
All the patients survived after Abbe flap transfer and repair, and the lip function and appearance of the patients were obviously improved after operation. Of the 32 cases, 28 cases were satisfied with both doctors and patients, accounting for 87.5%, 3 cases were good, accounting for 10%, and 2.5% were poor 1 case. Among the 4 cases with good and poor results, the main problem is that the thickness of the transferred Abbe flap is different from that of the original upper lip tissue, and some cases have small groove depressions on the red surface of the lip, which need to be re-performed.
discuss
Abbe's flap mostly refers to repairing the defect of upper lip with lower lip. In a broad sense, Abbe's flap also includes repairing the defect of lower lip with upper lip. For patients with lip defect, various regional skin flaps can be used to repair the defect according to the specific conditions of the defect. Abbe flap, as a method of lip defect repair, is mainly used to repair deformities after cleft lip surgery, traumatic lip defect and lip tumor resection due to its own characteristics.
For the repair of lip defect, the key point is the recovery of function, which needs to achieve beautiful results.
Aesthetically speaking, the length of the upper lip is about 7 ~ 8 cm, the length of the lower lip is about 6 ~ 7~8cm, and the upper lip is longer than the lower lip 1cm. In addition, after a lot of observation and measurement, Vegter-F and others came to the conclusion that the ratio of the length of the upper lip to the lower lip should be the ratio of the angle of mouth to the point of the upper tragus and the angle of mouth to the point of the lower tragus, which can be used as a reference and evaluation index for the clinical repair effect.
In the repair of lip defect, the repair of red lip defect is a clinical difficulty and it is difficult to achieve satisfactory results for both doctors and patients. However, because the transferred tissue of Abbe flap is labial red tissue, the effect of repairing labial red defect is ideal. Abbe flap can increase the fullness of upper lip tissue and prolong the upper lip, which is especially suitable for the correction of short upper lip deformity after unilateral and bilateral cleft lip surgery. For patients with short nasal columella after bilateral cleft lip surgery, sometimes Abbe flap+costal cartilage or auricular cartilage can be implanted to extend the nasal columella to correct upper lip tension, which can achieve satisfactory results.
Abbe valve has many advantages, but it also has disadvantages. Because Abbe flap mostly uses the lower lip to transfer to the upper lip to repair the defect in the middle of the upper lip, there are lip bead, labial arch and other anatomical structures in the middle of the normal upper lip, but the lower lip does not have these structures, so there are still some aesthetic defects when the lower lip transfers to the upper lip to repair the defect. In addition, generally speaking, the lower lip is thinner than the upper lip, so when the lower lip is transferred to the upper lip for repair, the red tissue of the repaired Abbe flap will sometimes be not full, which can be corrected by additional minor operations such as red lip crossing. Sometimes there are some defects such as depressions and small grooves on the edge of the Abbe flap from the lower lip to the upper lip, which are also caused by the suture technique of the Abbe flap or poor blood supply. In addition, the deformity caused by the lack of tissue in the donor valve area is also a problem that can not be ignored. It takes two operations to repair the lip defect by this method, and the patient can't eat with his mouth open between operations. Some patients who are used to breathing with their mouths open should pay attention to the tension of the pedicle of the flap when sleeping, so as to avoid the blood supply disorder of the flap caused by the excessive tension of the lip flap. The application range of Abbe valve is also limited. Abbe flap is not suitable when the lip defect is large, that is, the lip defect exceeds the lip length 1/2. Generally, the width of Abbe valve should be less than 2cm. When the base width of Abbe flap is large, it often leads to small mouth deformity after suture, which needs to be corrected by other operations such as small mouth enlargement.
At present, doctors still have different opinions on how to repair lip defect with add flap. Looking up domestic and foreign literature, there are few reports. However, according to our clinical experience, as long as we carefully design according to the types of defects, choose appropriate indications, pay attention to surgical operation skills, and properly handle and care after operation, we can achieve satisfactory therapeutic results by using Abbe flap to repair lip defects.