The whole flap was now rotated upward on an arc of 180° and sutured into the labial defect, as shown in [Fig. 244].
The large wound of the neck was readily drawn together by suture, leaving only a small triangular space to heal by granulation.
As has been mentioned, the skin of the neck is not adaptable for this purpose, not only because of its poor nourishment and extreme thinness, but because a flap made therefrom is devoid of muscular structure, contracts easily, and is devoid of a mucous-membrane prolabium, the greatest objection being in the resultant contraction of the lip so formed, which usually constitutes so high a degree of ectropion of the lip as to allow the saliva to escape from the mouth.
Apart from the ingenuity of the method it has no practical value, for the reasons given.
Fig. 243. Fig. 244.
Delpech Method.
Larger Method.—Larger restores two thirds of the lower lip after the ablation of an epithelioma, as follows:
1. An incision is made from the union of the left third with the right two thirds of the upper lip, directed toward the alæ of the nose and including the entire thickness of the lip, the cul-de-sac, and the buccal mucous membrane.
2. A second incision is made from the upper extremity of the first incision downward from the nasolabial fold to a point on the cheek a little below and to the left of the left labial commissure. The flap being turned down, is sutured by its three edges to the lip of the quadrangular breach, after the lower edges of the flap has been freshened; this border being formed by the mucous membrane of the upper lip, the membrane is destroyed in order to permit of the edge being sutured to the horizontal branch of the loss of substance. The upper lip is then sutured vertically to the cheek.