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Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 334 - файл
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ab
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Fig. 11.18 Excison and primary closure. (a) Markings for excision, (b) Final closure
11 Lips/Chin
Upper Lip (Philtrum/Lateral)
https://t.me/medicina_free
415
Bilateral/Unilateral Advancement Flap
Indications: Small- and medium-sized defects.
Technique: The defect is modied to obtain parallel lateral edges and extended
superiorly and inferiorly to place the nal suture line along the vermillion and base
of nose, alar facial sulcus. The lateral aps are raised in the subcutaneous plane, and
any dog ears excised along the alar facial sulcus. The wounds are closed in layers
(Fig.11.19a–d).
Tips: The difference is length of the wound margins can be accommodated by
differential suturing. Any dog ears that develop are excised along the alar facial
sulcus and commissural rhytids. Accurate approximation of the vermillion is mandatory. In unilateral aps, the medial suture line can be placed along the philtral
ridge or perioral rhytids. Excision of muscle and mucosa is often needed to accommodate the excess tissue but is less than the skin excision.
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a
b
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11 Lips/Chin
c
Fig. 11.19 Bilateral advancement aps. (a) Markings for excision, (b) Excision defect, (c) Flaps
raised, (d) Final closure
d
Upper Lip (Philtrum/Lateral)
https://t.me/medicina_free
417
A-T Flap
Indications: Small defects, close to vermillion.
Technique: The defect is converted to a triangle, with the base along the vermil-
lion border. Skin incisions are made laterally from the base of the triangle, along the
vermillion border. The aps are raised in a subcutaneous plane and mobilised into
the defect. The wound is closed in layers (Fig.11.20a–c).
Tips: The difference is length of the wound margins can be accommodated by
differential suturing. Any dog ears that develop are excised along the perioral and
commissural rhytids and by extending the vertical limb into the mucosal aspect.
Accurate approximation of the vermillion is mandatory. Consideration can be given
for converting to full-thickness defects.
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11 Lips/Chin
a
b
c
Fig. 11.20 A-T ap. (a) Markings for excision, (b) Excision defect and aps raised, (c)
Final closure
Upper Lip (Philtrum/Lateral)
https://t.me/medicina_free
419
Unilateral/Bilateral Perialar Crescentic Advancement Flap
Indications: Medium-sized defects.
Technique: The defect is modied to obtain parallel lateral edges and extended
superiorly and inferiorly to place the nal suture line along the vermillion and base
of nose, alar facial sulcus. The lateral aps are raised in the subcutaneous plane, and
any dog ears planned for excision along the alar facial sulcus. The wounds are
closed in layers (Fig.11.21a–d, e–g).
Tips: The difference is length of the wound margins can be accommodated by
differential suturing. Any dog ears that develop are excised along the alar facial
sulcus and commissural rhytids. Accurate approximation of the vermillion is mandatory. In unilateral aps, the medial suture line can be placed along the philtral
ridge or perioral rhytids. Excision of muscle and mucosa is often needed to accommodate the excess tissue but is less than the skin excision.
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ab
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11 Lips/Chin
c
d
ef
g
Fig. 11.21 Perialar cresentric advanceement ap. (a) Markings for excison and ap, (b) Excision
defect, (c) Flap raised, (d) Final closure, (e) Markings for excision, (f) Excision defect, (g)
Final closure
Upper Lip (Philtrum/Lateral)
https://t.me/medicina_free
421
Laterally Based Rotation Flap
Indications: Small defects, away from vermillion.
Technique: The defect is modied into a triangle to place base along the nasal
base/nasolabial fold. A curvilinear incision is made from the base of the defect,
along the nasolabial fold. The ap is raised in a subcutaneous plane, and the dissection extended inferiorly to the vermillion junction. The wound is closed in layers
(Fig.11.22a–c, d–k).
Tips: The difference is length of the wound margins can be accommodated by
differential suturing. Any dog ears that develop are excised along the alar facial
sulcus. Accurate approximation of the vermillion is mandatory, and the wound can
be extended inferiorly into the mucosa, to accommodate for any increase in length
of the vertical component.
422
ab
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11 Lips/Chin
c
d
e
Fig. 11.22 Laterally based rotation ap. (a) Markings for excision and ap, (b) Excision defect
and ap raised, (c) Final closure, (d) Markings for excision and ap, (e) Excision defect, (f) Flap
incisions, (g) Flap raised, (h) Trial mobilisation, (i) Initial closure with delineation of dog ears, (j)
Final closure, (k) Post operative appearance
f
Upper Lip (Philtrum/Lateral)
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g
i
h
j
k
Fig. 11.22 (continued)
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