a) Burn with ectropion of the lower lip (Fig. 6.32)
A small contracture causing ectropion of the lower lip can be dispersed with one, two, or more Z-plasties to lengthen the lower lip and restore the everted vermilion to a normal position (Fig. 6.32b).
b) Severe burns
A more severe contracture with fixation of the lower lip and destruction of the underlying skin can be managed much as in the upper lip (see Fig. 6.12) by excising the scar and then mobilizing the vermilion
Fig. 6.29 Neurovascular myocutaneous island flap of Weerda (1981, 1990; see Fig. 6.17).
a The flap can be cut in two layers (with mobilization of the cheek mucosa) or three layers, preserving its neurovascular pedicle.
A = superior labial artery V = vein N = facial nerve b The flap is advanced into the upper lip defect, and Burow's triangles are excised. c The completed repair
S = mucosal flap from the oral vestibule; D = de-epithelialized area.
Fig. 6.30a, b Excision of a scar at the commissure. A Z-plasty is used to disperse the scars and place them in the RSTLs.
and shifting it upward. After making a pattern, we cover the defect with a full-thickness retroauricular skin graft (see Fig. 6.12c). The repair should be immobilized with a tie-over dressing for approximately 1 week (see Fig. 6.12d).
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