Clinical Analysis Of Three Kinds Of Local Flaps For Repairing Large Full-thickness Defect Of Lower Lip

Objective:To investigate the long-term clinical efficacy of the Bernard-Webster flap,Yu flap and Karapandzic flap for repairing the lagre full-thickness defect of the lower lip,and to provide reference for the selection of local flap for repairing the lagre full-thickness defect of the lower lip.Methods:This study collected from June 2015 to December 2020,the first affiliated hospital of nanchang university of oral and maxillofacial surgery meet the inclusion criteria of cases of large full-thickness defect of lower lip,a total of 20 patients,14 cases of male,female 6 cases,age from 52 to 91,defect range from 70 to95%.according to the operation method,were divided into Bernard-Webster flap group 5 cases,Yu flap group 7 cases and Karapandzic flap group 8 cases.The preoperative preparation and postoperative routine treatment of the three groups were the same.Patients were required to be followed up regularly after surgery for no less than 12 months.According to the criteria of the evaluation table for the clinical efficacy of the lower lip,the follow-up results of 12 months after surgery were selected to conduct a comprehensive analysis of the long-term efficacy after surgery.Statistical methods were used to compare the appearance and function of the lower lips which were reconstructed and the subjective satisfaction evaluation results of the patients,and to analyze whether the differences between the groups were statistically significant.Results:In this study,all the flaps of the 20 patients survived,and the wounds got primary healing without complications such as hematoma,wound dehection and infection.No tumor recurrence was observed during the follow-up period.In terms of aesthetics,there was no significant difference in the symmetry of the mouth Angle and the exposure of red lips among the three groups(P > 0.05).The bilateral mouth angles of the lower lip were basically symmetrical and the red lips were harmonious and natural.However,in the case of microstomia,in the lower lips reconstructed with Bernard-Webster flap and Yu flap,there was 1 case of slight microstomia respectively,and in the lower lips reconstructedwith Karapandzic flap,there were 3 cases of slight microstomia,and 5 cases of moderate microstomia.There was statistical significance in microstomia between the three groups of local flap(P < 0.05).In terms of function,although the function of Yu flap group and Karapandzic flap group recovered more quickly after surgery,four(80%)patients with Bernard-Webster flap had some type of dysfunction early postoperatively(e.g.:salivating at rest,fluid effusion with water,mouth opening difficulties,eating disorders,speech disorders,and/or subjective neuroparesthesia).None of the patients had complete lip or chin numbness.5 patients with Bernard-Webster flap were able to return to normal diet and oral hygiene 30 to45 days after surgery.At the follow-up 12 months after surgery,the sensory function of patients in the three groups was basically restored,and there was no obvious disturbance in speech,chewing,eating and expression,and no saliva leakage occurred.There was no statistical significance in the long-term lip function between the three groups after the operation(P > 0.05).In terms of patient subjective satisfaction,90%(18/20)of the patients were very satisfied with the postoperative efficacy,and 10%(2/20)of the patients were basically satisfied with the postoperative efficacy,including 1 case of Karapandzic flap and 1 case of Bernard-Webster flap respectively.There was no statistical significance in the long-term satisfaction of the patients in the three groups after skin flap(P > 0.05).Conclusion:1.In terms of patient subjective satisfaction,Bernard-Webster flap,Yu flap and Karapandzic flap can all achieve satisfactory long-term clinical efficacy for repairing the lagre full-thickness defect of the lower lip in middle-aged and elderly patients.2.In terms of aesthetics,Karapandzic flap group is inferior to Bernard-Webster group and Yu flaps group,and microstomia often occurs,while Bernard-Webster group and Yu flaps group can generally maintain the original size of the mouth cleft.3.In terms of function,Bernard-Webster flap group often has functional abnormalities of varying degrees in the early postoperative stage.The function of Yu flap group and Karapandzic flap group recover quickly after surgery,but there is no significant difference in the long-term function of the three types of flaps.4.Based on comprehensive analysis,Yu flap is recommended as the first choice,Karapandzic flap is the second,and Bernard-Webster flap is the last when local flap is considered for for repairing the lagre full-thickness defect of the lower lip...