邹璇 路荣建 初晓阳 杨利利 于开涛

[摘要]目的：探索改良Gillies扇形全厚组织瓣在下唇中重度缺损修复与功能重建中的应用，规范手术设计与方法，总结临床矫治经验。方法：对2008年1月-2019年12月笔者科室收治的15例下唇中重度缺损患者采用改良Gillies扇形全厚组织瓣进行修复与重建，提出了获得性唇缺损畸形的分类，规范了手术设计与手术方法。结果：15例中重度下唇缺损的患者，用单侧改良Gillies扇形全厚组织瓣修复唇缺损12例，双侧改良Gillies扇形全厚组织瓣修复唇缺损3例，重建了口轮匝肌的连续性，获得了理想的唇外形及功能。结论：改良Gillies扇形全厚组织瓣手术设计与手术方法规范，临床病例证实改良Gillies扇形全厚组织瓣修复下唇中重度缺损，能获得良好的唇外形及运动功能，有重要的临床应用价值。

[关键词]唇缺损;改良扇形组织瓣;修复;功能性重建

[中图分类号]R782.2+5    [文献标志码]A    [文章编号]1008-6455（2021）05-0066-04

Application of Modified Gillies Fan Flap in Repair and Functional Reconstruction of Moderate-severe Full-thickness Lower Lip Defects

ZOU Xuan， LU Rong-jian， CHU Xiao-yang，YANG Li-li，YU Kai-tao

（Department of Stomatology， the Fifth Medical Center of Chinese PLA General Hospital， Beijing 100071，China）

Abstract： Objective  To explore the application of the modified Gillies full-thickness fan flap technique for the repair and functional reconstruction of moderate-severe lower lip defects， and to regulate the surgical design and methods as well as to summarize the experience of clinical correction. Methods  From January 2008 to December 2019， a total of 15 cases with moderate-severe lower lip defects receiving repair and reconstruction with modified Gillies full-thickness fan flaps were included in this study. The classification of acquired lip defects and deformities was proposed， and the surgical design and methods were regulated. Results  Among the 15 cases with moderate-severe lower lip defects， repair using unilateral modified Gillies full-thickness fan flap was performed in 12 cases， and bilateral modified Gillies full-thickness fan flap was performed in three cases. The continuity of the orbicularis oris muscles was restored， and ideal lip appearance and functions were obtained. Conclusion  The surgical design and methods for modified Gillies full-thickness fan flap were regulated. The clinical cases confirm that treatment of moderate-severe lip defects with modified Gillies full-thickness fan flap tends to achieve good lip appearance and motor functions， which is of significant value for clinical application.

Key words：lip defect; modified fan flap;repair;functional reconstruction

唇是口腔的重要組成部分，不仅与语言、咀嚼及吞咽有关，而且与面容、美观及情感的表达有着密切关系。唇缺损畸形可分为先天性缺损畸形和获得性缺损畸形，后者在临床上常因肿瘤切除[1-4]、外伤[5-8]、烧伤[9-10]、特异性炎症[11-14]等因素所致，唇缺损畸形不仅影响到患者的面容及功能，而且还常致患者严重的心理障碍。

唇缺损的修复方法可分为三类：①直接关闭缺损;②局部皮瓣修复;③远位皮瓣重建。自19世纪中叶以来，下唇缺损重建方法文献报道超过200种[15]。就中、重度下唇全厚缺损的修复与重建……