Plastic and cosmetic surgery

by Frederick Strange Kolle

The two strips of prolabium will be found to stretch easily. They are utilized to line the entire denuded raw surface and are held in position by a number of fine silk sutures, as shown in [Fig. 252].

Fig. 251. Fig. 252.

Dieffenbach-Von Langenbeck Method.

Accessory mobilizing incisions, as shown in the above figures, may be necessary to contract the oral orifice sufficiently to permit of such a prolabial grafting, especially where a greater part of the vermilion border has been destroyed. These extra incisions are not necessary when only a small part of the latter is lost; a partial unilateral dissection in that case would suffice to restore the part.

This prolabial lining of the mouth gives it a puckered and contracted appearance for a time only, because the parts soon stretch, while oral gymnastics will help much in restoring its size and usefulness.

The objection to the above method is the danger of partial or total gangrene of that part of the prolabium which has been dissected up and stitched to line the mouth as a result of lack of nutrition or to the bruising or rough handling of the delicate strips during the operation.

Tripier Method.—Tripier refashions the prolabium of the mouth by means of a mucous strip taken from the inner surface of the lip. This strip is left attached at both ends, forming a bridge flap of mucous membrane, the pedicles of the ends giving nourishment to the whole. The bridging strip is slipped into place and is sutured to the outer skin by its superior border, so as to restore the normal appearance and thickness of the lip.

Antisepsis must be carried out scrupulously and a strip of iodoform gauze be placed between the lips operated upon and the gum. In forty-six cases operated upon by this method forty-two were successful, while in two of the unsuccessful cases there was partial gangrene of the flap.

Macrostoma and Overdevelopment of the Lips.—In the cosmetic correction of macrostoma there may be an overdevelopment of one or both lips as well as the wide oral fissure. In such cases the lip structures is to be reduced by the methods heretofore given, before shortening of the mouth line is undertaken, because of the greater freedom allowed the surgeon to correct the deformity.