整容的に重要な自由縁をもつ口唇のマイクロサージャリーによる機能の再建

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  • Functional Reconstruction of Large Lip Defects with Microsurgical Techniques

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 Lip defects may result from trauma and resection of malignant tumors. The lips not only provide function in feeding but are important for speech and the maintenance of facial expression. Reconstructive surgeons have to consider how to reconstruct these functions. In this article, we describe the surgical techniques of functional lip reconstruction. When the amount of resected tissue includes the entire lip mass, reconstruction by a free flap should be considered. The most commonly used free flap is a radial forearm. The forearm flap can be used by sensate flap with attaching a sensory nerve. Furthermore, a forearm flap is usually transferred along with the palmaris longus tendon, and this tendon has been used for the suspension of the lower lip by suture to the perioral skin, periosteum, or remnant orbicularis oris muscle. However, the palmaris longus tendon graft is a so-called static reconstruction, in order to avoid downward distortion of the lower lip. Recently, lip reconstruction using the gracilis muscle was reported. By suturing the obturator nerve to the facial nerve, the gracilis muscle can move voluntary and work as the orbicularis oris muscle. However, to cover the gracilis muscle, a skin graft or other skin flap should be transferred. The sensation of the lip and oral surface is also important for feeding. The combination of innervated gracilis muscle and sensate forearm flap allows for the reconstruction of the dynamic function and sensations of the lip.

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