Burns, caustic injuries, and scar contractures can cause severe distortion of the upper lip. The revision technique is as follows:
1. The scar is excised down to muscle, and the vermilion is mobilized (Fig. 6.12a, b).
2. A pattern is made out of paper, cloth, or aluminum foil (Fig. 6.12b).
3. The pattern is used to harvest a full-thickness ret-roauricular skin graft (Fig. 6.12c).
4. The full-thickness skin graft is inset using fibrin glue and 6-0 or 7-0 sutures. Alternating sutures are left long (Fig. 6.12c, d).
5. The long sutures are tied over a foam bolster or Vaseline gauze dressing for 6-7 days (Fig. 6.12e).
Fig. 6.12 Large burn scar of the upper lip covered with a full-thickness skin graft. a Distortion of the upper lip following burn scar contracture. b The scar is carefully excised, and the vermilion is mobilized. A pattern is made. c A full-thickness retroauricular skin graft is harvested using a pattern made of paper or aluminum foil (suture wrapper).
d The full-thickness skin graft is sutured into the defect with 5-0 monofilament. Every other thread is left long (see Fig. 2.22). e The long threads are tied over a foam bolster or Vaseline gauze to create a light pressure dressing (see Fig. 2.22).
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