Plastic surgery; its principles and practice . IPS 527 tually form the vermilion border of the new lip. The skin and mucosaare sutured together in all places where this is possible. This proceduremakes an opening twice the length of the normal mouth. After severalweeks the scar tissue is removed from the edges of the lip defect andalong the upper border of the cheek incision. Lateral incisions aremade on each side from the corners of the mouth downward, and parallelto the borders of the lip defect, and the flaps thus made, including thefull thickness of the cheek, are shifted toward the midlin
Plastic surgery; its principles and practice . IPS 527 tually form the vermilion border of the new lip. The skin and mucosaare sutured together in all places where this is possible. This proceduremakes an opening twice the length of the normal mouth. After severalweeks the scar tissue is removed from the edges of the lip defect andalong the upper border of the cheek incision. Lateral incisions aremade on each side from the corners of the mouth downward, and parallelto the borders of the lip defect, and the flaps thus made, including thefull thickness of the cheek, are shifted toward the midline. Suturesare inserted and the lip and mouth reconstructed. The lateral open-ings left by shifting the flaps are filled by undercutting and shifting inthe soft parts. A similar procedure may be used on one side only if thedefect is unilateral. Nelaton and Ombredannes Operation for Extensive Loss of Sub-stance of the Lower Lip.—The defect is first made triangular in vertical incision is made on the neck from the apex of the Fig. 593.—Operation for the reconstruction of the lower lip in extensive defects(modified from Nelaton and Ombredanne).—i and 2. The dark line indicates the incisionmade on each side of the defect to form the flap X. From the angles of the mouth incisions are made through the skin only,to just below the tragus, and then from this point parallel to the borderof the defect downward below the lower edge of the mandible. Themucous membrane is then divided on the cheek cm. (about 3^3inch) above the skin incision, and in reflecting the flap downward theoperator also divides it along the anterior border of the membrane is sutured to skin to form a new vermilion flaps are reflected, care being taken not to disturb the parotidgland or the facial artery. After excision of the glands the lower 528 PLASTIC SURGERY mucous border is sutured to the mucosa of the lower jaw, and the flapsare raised and the necessary sutu
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