The usual treatment for actinic damage of the lower lip with premalignant changes is to remove the entire vermilion of the lower lip. The mucosa lining the oral vestibule is then mobilized and advanced to resurface the lip with an excellent cosmetic result. The skin-vermilion border is carefully restored using 6-0 or 7-0 monofilament, which is removed on the fifth or sixth day (Fig. 6.42b). In all lip reconstructions, the mucosal surface of the lip should be coated with
Fig. 6.42 Vermilion reconstruction by the method of von Lan-genbeck (1855).
a The premalignant vermilion has been completely resected. The mucosa of the oral vestibule is mobilized, advanced over the raw surface, and sutured into place. b Closure of the defect. c Cross-sectional view of the operation.
petroleum jelly to keep it from drying out. The resurfaced lip shows an initial livid discoloration that looks dangerous but is usually harmless and should clear within a few days.
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