Bruns Method.—Bruns removes the defect in quadrilateral form when the disease involves one half or more of the lower lip, as shown in [Fig. 214]. He encircles the mouth by two curved incisions to aid in mobilizing the edges of the wound, which he sutures, as shown in [Fig. 215], leaving two crescentic wounds at either side of the mouth, which are allowed to heal by granulation.
Fig. 214. Fig. 215.
Bruns Method.
Buck Method.—Buck has corrected a unilateral defect by employing the wedge-shaped incision, as shown by B, C, D in [Fig. 216]. After removing the triangular infected area he detaches the remaining half of the lip from the jaw as low down as its inferior border and as far back as the last molar tooth. A division of the buccal mucous membrane along the same line more readily permits of sliding the remains of the lip over to meet the raw surface opposite.
If the latter was not possible he obtained additional tissue by making a transverse incision from the angle of the mouth across the cheek to the point A, or within a fingers breadth of the muscle. A second incision is made downward from A and a little forward to the point E. This quadrilateral flap thus formed, with its upper half lined with mucous membrane is dissected up from the jaw except at its lower extremity. It is glided forward edgewise to meet the remaining half of the lip, where it is sutured into place, as shown in [Fig. 217].
To cover the triangular raw space occasioned by the sliding forward of the flap A, B, C, E, another transverse incision is made through the skin continuing the line A, D, [Fig. 217], to the extent of one inch. The skin is then dissected up as far as this incision will allow and is stretched forward until the edge meets the outer skin margin of the quadrilateral flap, to which it is sutured. A later operation for the restoration of the mouth has to be made.
Fig. 216. Fig. 217.