Plastic surgery; its principles and practice . Fig. 638.—Combination operation for the relief of constriction of the buccal orifice,cdntinued.— i. The mucosa flaps sutured to the skin to form the lip borders. 2. The skinflaps after being shortened are turned in to line the commissures. Werneck subsequently formed the commissure by turning in a flapof skin after excising the mucosa. In this operation he did not utilizethe mucosa as in his first operation. I have had excellent results with Dieftenbachs triangular flap ofmucosa to form the commissures. Nevertheless, there is much to be S50 PLASTI
Plastic surgery; its principles and practice . Fig. 638.—Combination operation for the relief of constriction of the buccal orifice,cdntinued.— i. The mucosa flaps sutured to the skin to form the lip borders. 2. The skinflaps after being shortened are turned in to line the commissures. Werneck subsequently formed the commissure by turning in a flapof skin after excising the mucosa. In this operation he did not utilizethe mucosa as in his first operation. I have had excellent results with Dieftenbachs triangular flap ofmucosa to form the commissures. Nevertheless, there is much to be S50 PLASTIC SURGERY said in favor of forming the commissures from small skin flaps whichare turned in and sutured to the mucosa within. At the same time themucosa which is behind the constricted portion should be utilized incovering the margin of the lips. In other words, a combination of. Fig. 639.—Result of enlarging the buccal orifice after atresia following a burn of themucous membrane.—i and 2. The outer margin of the vermilion border around the entiremouth had been burned, together with the surrounding skin. The mouth could be openedonly wide enough to admit a teaspoon. The constriction being somewhat like a puckeringstring. The photographs were taken six months after the excision of the constricting band,with plastic reconstruction of the commissures and vermilion border. Wernecks first and second operations seems to be the best for assuringthe commissures and avoiding recurrence. I have not found any groupof patients who are more grateful than those who have been relievedfrom marked atresia of the mouth.
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