Plastic surgery; its principles and practice . I 2 34 Fig. 608.—Cheiloplasty (Morestin).— i. The dark lines indicate the incisions. Theflap of scar X with pedicle above, which is turned up to line the lip. The buttress flap, double pedicled flap Z which is raised. 2. Shows the flap Z raised and placed abovethe buttress Y. 3. Diagrammatic midline section. The flap AB corresponds to the flapZ. The flap C corresponds to the flap X. 4. The flaps in position. as needed, the submaxillary glands are removed, a separate incisionbeing required for the submental gland. The edges of the cheek flaps
Plastic surgery; its principles and practice . I 2 34 Fig. 608.—Cheiloplasty (Morestin).— i. The dark lines indicate the incisions. Theflap of scar X with pedicle above, which is turned up to line the lip. The buttress flap, double pedicled flap Z which is raised. 2. Shows the flap Z raised and placed abovethe buttress Y. 3. Diagrammatic midline section. The flap AB corresponds to the flapZ. The flap C corresponds to the flap X. 4. The flaps in position. as needed, the submaxillary glands are removed, a separate incisionbeing required for the submental gland. The edges of the cheek flaps 534 PLASTIC SURGERY are then sutured in the midline, and are fixed and supported by thebuttress on the chin. Tension sutures may be necessary, and the anglesof the mouth may have to be lengthened (Fig. 609). Flaps from the upper lip may be unilateral or bilateral, accord-ing to the width of the defect. They have the advantage of beinglined with mucosa and the utilization of a portion of the red border of. 12 34 Fig. 609.—Operation for restoring the lower lip (Grant).—i and 2. The dark linesindicate incisions made in removal of growth on the lip, and for the plastic repair. retraction of the tissues after the incisions are made. The tissues on the chin arenot disturbed. 4. Shows the wound closed. This operation is a good one and has theadvantage of a buttress on the chin. the upper lip near the angles insures a satisfactory commissure. Theseflaps seldom evert, and good results are usually obtained. Largers Operation (1894).—An incision is made through the fullthickness of the upper lip at the junction of the outer and middlethirds. This is extended upward and outward toward the ala, to thenaso-labial fold. Joining this a second incision is made parallel to this Kj \ r )j\
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