Reconstruction of upper lip with folded and transplanted ulnar free flap of forearm

Forearm ulnar flap fold free graft upper lip reconstruction for lip reconstruction after lip cancer resection. Treating diseases: lip cancer Indication Forearm ulnar flap fold free graft upper lip reconstruction is suitable for: 1. The patient is in good general condition and can withstand this operation. 2. A wide range of defects in the upper lip, bilateral cheeks, nose, nasal column, teeth and maxillary condyle. Contraindications 1. The brachial artery blood supply is not suitable for this operation. 2. Patients with scars on the ulnar side of the forearm should not cut the flap. 3. This surgery should not be used for small defects in the 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, incision of the skin, subcutaneous, platysma, separation of the anatomical free facial artery and external jugular vein, rubber sheet protection. From the submandibular incision to the ipsilateral buccal edge, a 2.0 cm wide subcutaneous tunnel was made under the skin to prepare the flap for vascular pedicle loosening and hemostasis. 2. Forearm ulnar flap excision 1 flap design: the symmetrical trifoliate is designed with the ulnar artery and the important vein as the axis, and the methylene blue line is drawn. 2 flap removal: cutting (with "forearm ulnar flap (fold) free graft buccal reconstruction"). 3. Flap transplantation lip, cheek, nasal reconstruction 1 vascular anastomosis: after the flap was broken, it was transplanted into the defect area. The forearm donor site was routinely removed from the abdominal or lateral chest full thickness skin repair. The venous and venous pedicles of the flap pass through the tunnel to the submandibular area. The ulnar artery and the facial artery, the superior vein and the external jugular vein were anastomosed with a 9-0 non-invasive suture under the operating microscope. 2 lip, cheek, and nasal reconstruction: the center of the flap is symmetrical. The two large leaves are folded behind the small column. The two small leaves next to the large leaf are folded in half to form a bilateral nose. The two small leaves form a bilateral relationship with the central large leaf. nostril. The rest of the flap was folded in half to repair the upper lip and part of the buccal defect, and the 1-0 suture was sutured to suture the wound edge. 3 suture the submandibular wound and place the rubber drainage piece: wash the wound with saline in the tunnel, observe the condition of the flap and the anastomotic anastomosis of the blood vessel. Then place a 2.0cm wide rubber drainage piece and suture the submandibular incision 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.

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