Plastic and cosmetic surgery

by Frederick Strange Kolle

Richerand Method.

If the neoplasm or defect is of a more extensive form, involving most or all of the prolabium, the entire area, including the necessary allowance of healthy structure, may be raised up by a clamp, as shown in [Fig. 208], and excised. The mucous membrane from the anterior surface of the lip is then brought forward and sutured to the skin margin, as in [Fig. 209]. The disfigurement in this operation is surprisingly little, and the mucous membrane thus everted takes on the appearance of the vermilion border of the lip in a short time.

Fig. 208. Fig. 209.

Extirpation of Entire Vermilion Border.

Celsus Method.—When the neoplasm has become more than superficial, or the defect or deformity involves more than the prolabium, it must be ablated by a wedge-shaped incision, the base upward including the vermilion border and the apex extending downward upon the anterior chin.

This is best performed by piercing the tissue with a sharp bistoury, the blade penetrating the mucosa, while an assistant compresses the coronary vessels with his fingers at either angle of the mouth.

The incision must be made well into the healthy tissue, or at least 1 cm. from the boundary of the defect. The incision is made, as outlined in [Fig. 210], from below upward while the operator draws up the triangular mass to be removed with the fingers of his left hand. The same method is followed on the other side. The wound margins are then to be examined microscopically for any sign of malignant involvement. If there be any it should at once be removed, irrespective of the size of the wound occasioned thereby. For this reason the area excised may be so large as to prevent the ready apposition of the raw edges. Should this occur, the lip halves may be made more mobile by adding a horizontal incision continuous from the angle of the mouth outward and over the cheek, as shown in the line A, C.

A single incision for a unilateral defect and one on either side for a median excision, as shown by the lines A, C, and B, C, in the same figure.

This operation is known as the Celsus method. The parts are brought together and the sutures placed as in [Fig. 211], beginning the first deeply and nearly to the mucous membrane, just below the prolabial margin, which controls the bleeding. One or two of the sutures should be made deeply to overcome the tension of the parts as far as possible.