Reconstruction of lower lip with free forearm ulnar myocutaneous flap transplantation

Forearm ulnar musculocutaneous flap free graft lower lip reconstruction for lip reconstruction after lip cancer resection. Treating diseases: lip cancer Indication Forearm ulnar musculocutaneous flap free graft lower lip reconstruction is applicable to: 1. The patient is in good physical condition and can withstand this operation. 2. A wide range of defects in the lower lip, part of the cheek and ankle. Contraindications This procedure should not be used for small areas of the lower lip. Preoperative preparation 1. 1d preoperative ultrasound Doppler detection of donor and recipient blood vessels, methylene blue line. 2. Surgical microscope and microvascular surgical instruments. The surgical instruments are prepared in two sets. 3. On the 3rd day before surgery, the oral cavity was cleaned with 1:5000 furancillin solution and 3% hydrogen peroxide dissolved hydrogen solution. The oral cavity was cured 1 day before operation. 4.5% of low molecular weight dextran solution is used intraoperatively, and heparin is used in surgery. 5. Clean the enema before going to bed 1 day before surgery. 6. Place a catheter on the morning of surgery. 7. The skin preparation and preoperative medication of the surgical site in the donor and recipient areas are the same as the general surgery, but the hemostatic drugs are disabled. Surgical procedure The operation was performed in two simultaneous sessions. 1. The defect area is cut and the tunnel is made Cut along the edge of the defect area, remove the scar tissue, and form a fresh normal tissue wound. One side of the submandibular incision, the anatomical facial artery and the external jugular vein were separated and protected by a rubber sheet. The subcutaneous tunnel was made from the submandibular incision to the iliac crest, with a width of 2.0 cm, in order to loosen the vascular pedicle and stop bleeding. 2. Forearm ulnar muscle flap removal 1 musculocutaneous incision design: According to the lower lip and ankle defect range, the musculocutaneous flap is designed with the ulnar artery and the main vein as the axis, and the methylene blue line is drawn. 2 musculocutaneous flap removal: according to the forearm ulnar flap removal method, but after the free ligation of the ulnar artery, the venous vein is fixed under the skin flap, the ulnar wrist flexor tendon is ligated at the wrist side and sutured and fixed to the skin. Under the flap, to prevent the muscle from separating from the flap, the suture is long enough for suture fixation with the upper lip rim muscle. The elbow side of the muscle flap is ligated at the edge of the flap and the long thread is reserved for fixing the other side of the needle. Diaphragm. 3. Dynamic reconstruction of the lower lip and ankle of the musculocutaneous flap 1 anastomotic vessels: the musculocutaneous flap was transplanted into the lower lip defect area. The forearm donor site was routinely removed from the abdominal or lateral chest full thickness skin graft for free graft repair. The ulnar artery and the venous vein pass through the tunnel to the submandibular area, and the ulnar artery and the venous vein are respectively anastomosed with the 9-0 non-invasive suture at the end of the surgical microscope. 2 lower lip and ankle reconstruction: the musculocutaneous flap is folded along the long axis of the vascular pedicle, and the two ends of the ulnar wrist flexor are sutured separately from the upper lip and the rim of the upper lip, so that the lower lip above the repaired lower lip The diaphragm is driven to move and achieve dynamic repair. The folded flap of the flap and the lip and ankle defect were sutured intermittently with a 1-0 suture. 3 suture the submandibular wound and place the rubber drainage piece: wash the wound along the tunnel with saline, observe the blood circulation of the musculocutaneous flap and the anastomosis of the blood vessel. A 2.0 cm wide rubber drainage piece was then placed and the submandibular incision was sutured intermittently with a 1-0 suture. complication 1. Anastomotic vasospasm, vascular pedicle twist, anastomotic leakage, hematoma formation and vascular embolization. 2. Postoperative wound infection. Oral contamination surgery, long time, trauma, ligature, and often cause infection after surgery. 3. For the first two reasons, it may cause partial and total necrosis of the flap. 4. Forearm donor area wound hemostasis is not complete, postoperative hematoma formation, can lead to partial or even necrosis of the skin graft. 5. When the forearm flap is cut, the level is not properly grasped, the tendon is exposed, and the tendon adheres to the tendon after skin grafting, which affects the function of the forearm.