This can be a sensate axial musculomucocutaneous flap based upon the superior and inferior labial arteries. It provides good oral competence and it is helpful for closing one-half to two-third defects from the upper lip and defects up to three-quarters from the lower lip. It's ideal in situations where no new lip tissue is required in central defects or lateral defects that involve the commissure. The circulation is more robust compared to Abbe flap, however the aesthetic outcome is inferior. Because new lip tissue isn't recruited, microstomia may result after closure of larger defects.
A semicircular incision of adequate length to close the defect is extended in the defect toward the commissures. Your skin incisions are made having a scalpel, and careful mobilization of subcutaneous tissues is achieved using electrocautery.
By spreading the orbicularis oris muscle longitudinally along the line of the incision, or on the plane parallel towards the fibers, separation in the adjacent musculature is attained while maintaining the nerves and vessels intact. Laterally, in the level of the commissures, your skin is incised only down to subcutaneous tissue.
Careful dissection is needed to identify and preserve the labial arteries and buccal nerve branches. The flaps are rotated medially to shut the defect, and a stay suture is positioned after meticulous reapproximation from the vermilion border. The defect is closed in three-layers approximating mucosa, muscle and skin.
Complications of the technique include microstomia and visible scarring. Secondary revision of the commissure is usually indicated to prevent oral crippling in feeding, hygiene maintenance and denture placement. The circumoral scarring following this procedure is more noticeable since the scars do not lie in natural skin creases.
The Estlander flap is modified to be used around the corner from the mouth. It's a one-step procedure but sometimes requires future revision to enhance the commissure. Continuity from the orbicularis oris ensures adequate oral competence; however, the modiolus functional region is distorted resulting in altered oral animation. This alteration is compounded by a rounded neo-commissure which lacks definition.
The flap is designed to actually cover half the width of the defect to cover. It's based on the opposite lateral lip. The vascular pedicle is at the pivoting point, given by the contralateral labial artery. It's rotated to the defect, and also the donor site is closed primarily.
Although most often used in lower lip reconstruction, this method can be handy in large defects of the upper lip as well. This is an advancement flap utilizing the residual lip tissue and the cheeks for closure from the defect. For closure of very large defects this technique can be coupled with an Abbe flap (from the opposite lip).
Closure technique is different for upper lip and lower lip defects. For that upper lip, a perialar excision of skin and subcutaneous tissue is conducted in the form of a triangle (or crescent). Burow's triangles are also excised lateral to the lower lip. Adequate mobilization of the flaps is achieved by looking into making bilateral incisions in the gingivobuccal sulci being careful to leave sufficient gingival mucosa for subsequent closure of the mucosal layer. The tissue is advanced medially to shut the defect and is sutured in three layers.
Your skin and subcutaneous tissue perialar incisions are closed in a single layer. Perialar crescentic excisions are more aesthetically pleasing but might not provide enough mobility. The vermilion is reconstructed using cheek buccal mucosa. The resulting insensate, nonfunctional upper lip doesn't usually result in oral incompetence. This is because gravity charges the low lip using the responsibility of oral competence.
The most typical complication of this procedure is microstomia, which could sometimes be improved by combining this method by having an Abbe flap. This technique may also cause some excessive tension on the upper lip and cheek resulting in distortion of the nasolabial fold.
In the Bernard-Burow's way of the low lip, four Burow's triangles are excised lateral towards the nasolabial folds and in the labiomental groove to allow relief space for advancement of bilateral lower cheek flaps medially to fill the defect. Excision of those triangles avoids an average tight lower lip and excess upper lip, and can vary in size so long as closure is achieved without tension.
A minor modification in the originally proposed procedure preserves innervation and function by avoiding deep dissection through perioral muscles. Although a bulkier upper lip and poor anterior projection in the vermilion is common, this process remains an appropriate option for reconstructing very large defects.
Our website is not responsible for the information contained by this article. Webworldarticles.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
This article was sent to us by:
Sean Barnes at
02142011
1. What is glycogen and what are disorders of glycogen storage
All articles in this directory are property of their respective authors. Additionally, read our Privacy Policy
© 2010 WebWorldarticles.com - All Rights Reserved. Partners: Gunblade Saga