[Modern approach in management of patients with lower third face lacerated wounds]

The use of a full-thickness donor flap for lip defect closure requires a fundamental reconsideration.

The aim of the study was to develop and demonstrate the effectiveness of an original bioengineering construct using a combination of a free connective tissue graft, a free periauricular skin flap, and the patient's own platelet-rich plasma, rich in fibrin, for lip defect reconstruction.

The study included 50 patients with lacerated lip wounds with soft tissue defects. PRF in the APRF modification was obtained from the patient's venous blood. The free connective tissue graft (CTG) was obtained traditionally from the patient's palate according to defect dimensions. The free skin flap (FSF) was harvested from the posterior surface of the earlobe, the wound edges were mobilized and sutured. In order to achieve prolonged stabilization of the defect edges and prevent conformational postoperative changes, circular muscle mobilization of the mouth was performed and fixed with an intramuscular guiding suture, along with the administration of Botulinum toxin type A (Microgen Relatox). Postoperatively, the patient underwent daily dressings, monitoring, and prevention of secondary infection. Broad-spectrum antibiotics were prescribed, as well as rabies and tetanus vaccinations.

A bioengineering complex was developed for lip defect reconstruction, the novelty and effectiveness of which are confirmed by invention patents. There were no cases of necrosis or rejection of the transplanted material. The surgery and subsequent monitoring were conducted on an outpatient basis. Stitches were removed after 14 days from the main defect area, after 7 days from the earlobe, and after 5 days from the hard palate. Sensitivity of the reconstructed tissues appeared on average after 3-4 months. The structure and color of the red border were optimized after 4-5 months. Recovery of blood supply in the created bioconstruct in the middle area was observed after 2 weeks. Basic voluntary lip movements were possible after 1-2 months.