Triangular Flap Repair

Triangular valve repair is used for the repair of unilateral cleft lip. The advantage of this method is that the fixed point is simple, easy for beginners to master, and easy to achieve good results. The surface markings and anatomy of the lips. Treatment of diseases: cleft lip preparation Cleft lip disease children need to be fully and carefully prepared before surgery. 1. Understand and correct bad diet and sleep habits before admission. Within 3 days after admission, you should know if you have a respiratory infection or other infectious disease, and perform local and systemic examinations, including heart, lung condition, nutritional status and weight. Local presence or absence of eczema, erosion, swelling and so on. Thoracic examination should be performed to focus on the presence of congenital heart disease and thymic hypertrophy. Blood tests should also be performed. Hemoglobin, white blood cells, and clotting time should be in the normal range. Otherwise, the cause should be identified and treated, and surgery should be performed after recovery. 2. Before the operation, take a picture of the front, side and front back position to record the nose and lip deformity. 3. 3d before surgery should start and insist on using a spoon to feed liquid food or breast milk, so that the postoperative system can fully adapt to this feeding method, avoiding the crying of sick children caused by hunger after surgery, resulting in increased tension in the operating area. 4. 1d before surgery should be prepared for skin, antibiotic skin test, if necessary, with blood for blood transfusion preparation. 5. Fasting 6h before surgery. If the sick child is crying due to hunger, oral 10% glucose 100ml can be taken 3 to 4 hours before surgery. Atropine antispasmodic and sedatives were injected 30 min before surgery. 6. Prepare a metal lip bow or wire lead pellet for reduction before surgery. Surgical procedure Fixed point Red lip high point 1 and human mid-cut point 2 are determined at the healthy side lip peak, and the distance of 1~2 is copied to point 3 as the repaired side red lip high point, so that 1~2=2 ~3, that is, to maintain the original shape of its lip arch. The midpoint of the healthy side of the nose is fixed at 4, and the distance of 4 to 1 is the normal upper lip height, that is, the height of the lip after repair. Measure the width of the healthy nostrils (from the root of the healthy side to the root of the nasal column), then point 5 and 6 on both sides of the affected side; make the width of the root of the point 5 to the nasal column and point 6 to The width of the roots of the nose is added to equal the width of the bottom of the healthy side. The bottom of the nose is symmetrical. From the point 3 to the parallel line to the point 7, the length should not exceed the mandible of the healthy side, after the cut, accept the triangular flap inserted on the opposite side to increase the lip height. At the highest point on the affected side, the point 8 is fixed, and the point 9 is set on the outer side. The distance of 8 to 9 points is required to be equal to 1 to 4 points minus the length of 5 to 3, that is, the length of 3 to 5 plus 8 to 9 The length is equal to the normal lip height of 1 to 4. According to the author's experience, the height of 8 to 9 is generally 4 mm for infants and 5 mm for adolescents. The points are 8 and 9 respectively, and the 3 to 7 lines are arcs with a radius, and the intersection points are 10, and the 8109 is a triangular flap embedded with height. Connect 3 to 5 lines and 6 to 9 lines to make the two equal. If necessary, move them slightly to be equal. The points identified above are all pierced into the skin with needles, methylene blue, which are easy to cut and suture. 2. Cut open Use the lip clip or finger to pinch the upper lip of the surgery. The affected side of the nasal cavity can be filled with a cotton ball to prevent blood from flowing into the pharyngeal cavity. Then use the No. 11 blade, designed as a full layer or 2/3 layer incision, while cutting the lip red at points 3 and 8, but slightly to the nose to retain some red lip tissue. When cutting the triangular flap 8109, it is necessary to make the top and bottom consistent. Pay special attention not to make the tip too thin, otherwise the tip will be easily necrotic. In the case of a third degree cleft lip, the skin of 69108 should be retained and can be rotated to the nose to repair the nasal floor. 3. Stop bleeding 4. Squatting and stripping The III degree cleft lip is wide, and in order to avoid excessive tension after suturing, the base of the affected side can be sneak free. That is, a parallel incision is made in the vestibular groove of the mouth, reaching the periosteum. Then, the incision is spread along the periosteum through the incision to the periphery of the base of the nose, and the nose is loosened to reduce the tension of the upper lip after suturing, and to help correct the deformity of the nose. After the free wound, the wound was temporarily filled with saline gauze to stop bleeding. 5. Stitching The wound edge of the oral mucosa was sutured with a silk thread, and the muscle layer was sutured with a thin thread. The number of needles should not be too much, but it must be exact and reliable, and no invalid cavity should be left to prevent infection. The skin is first sewed at a fixed point with a thin thread, and then sutured in sequence. The triangular flap tip can be subcutaneously sutured, that is, the subcutaneous tissue from the contralateral parallel incision tip is inserted subcutaneously through the tip of the triangular flap, and then passed out from the other side of the parallel incision and knotted. 6. Trimming the red lips The red lips on both sides should be turned into two intersecting red lips and the triangular flaps should be switched to each other to fill the red lips and avoid the formation of intermediate depression defects. The specific method is to make a parallel oblique oblique incision on both sides of the lip edge of the lip, and one of the incisions should be at the cracking point to form two opposite triangular petals. Cut the mucosa and part of the muscle layer, cross-position and suture, and obtain a fuller shape after trimming. 7. Wearing a lip and bow for fixation After the suture is completed, the saline gauze in the base of the vestibular groove on both sides is taken out to absorb the secretions in the nasal cavity and the oral cavity. Apply a benzoic acid sputum solution to the cheeks on both sides of the face to protect the skin, then put on a prepared lip bow (thick wire, 2mm in diameter) and fix it on the outside of the nose with tape to reduce the wound tension.

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