Clinical effects of expanded frontal flap and flip scar flap in repairing partial nasal defect
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摘要:
目的 探讨额部扩张皮瓣联合翻转瘢痕瓣修复鼻部分缺损的临床效果。 方法 采用回顾性观察性研究方法。2012年1月—2022年1月，空军军医大学第一附属医院收治26例符合入选标准的鼻部分缺损患者，其中男19例、女7例，年龄5~61岁。手术分4期进行，Ⅰ期在额部置入合适额定容量的长方形皮肤软组织扩张器（以下简称扩张器）并定期注水扩张。Ⅱ期行翻转瘢痕瓣移植重建鼻部内衬，瘢痕瓣面积较缺损面积扩大约10%；采用以缺损对侧眶上血管或滑车上血管为蒂的额部扩张皮瓣帯蒂转移修复鼻部缺损，扩张皮瓣面积较瘢痕瓣切取、翻转后的鼻部缺损面积扩大约20%。将扩张皮瓣供区直接拉拢缝合。皮瓣转移术后3周，行Ⅲ期皮瓣延迟术；延迟术后1周，行Ⅳ期皮瓣断蒂术。记录扩张器埋置个数、额定容量、注水量及扩张时间。观察患者Ⅰ期术后感染、血肿、扩张皮瓣破溃等及Ⅱ、Ⅳ期术后皮瓣血运障碍或坏死等并发症发生情况。所有患者至少随访1年，观察患者皮瓣色泽、额部供区瘢痕情况、两侧眉毛的对称度，以及鼻部外形、外鼻道通气功能。 结果 26例患者共埋置26个扩张器，扩张器额定容量为100~300 mL，注水量为扩张器额定容量的1.0~1.5倍，扩张时间为2.5~4.0个月（平均3个月）。各期手术后均未出现并发症。术后随访显示，皮瓣色泽与鼻部正常皮肤相近，额部瘢痕不明显，两侧眉毛基本对称，鼻部外形较佳，外鼻道通气功能未受影响，但部分患者有鼻尖表现点下旋或者鼻尖表现点不突出的情况出现。 结论 采用翻转瘢痕瓣重建鼻部内衬及预扩张后额部皮瓣重建鼻部皮肤、不联合游离软骨移植修复鼻部分缺损，术后鼻部外形较佳，且不会引起外鼻道通气功能异常。 Abstract:Objective To investigate the clinical effects of expanded frontal flap and flip scar flap in repairing partial nasal defect. Methods A retrospective observational study was conducted. From January 2012 to January 2022, 26 patients with partial nasal defects who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 19 males and 7 females, aged 5 to 61 years. The surgery was performed in 4 stages. In the first stage, a rectangular skin and soft tissue expander (hereinafter referred to as expander) with suitable rated capacity was planted in frontal region and expanded by injecting water regularly. In the second stage, flip scar flap was grafted to reconstruct nasal inner lining, whose area was about 10% larger than the area of defect. The expanded frontal flap with pedicle was transferred to repair the nasal defect, whose pedicle was supraorbital vessel or supratrochlear vessel on the contralateral side of the defect, and the area of expanded flap was 20% larger than the nasal defect area after resection and flipping of scar flap. The donor site of expanded flap was sutured directly. After 3 weeks of flap transferring, the flap was delayed in the third stage. After 1 week of delaying operation, the pedicle of flap was cut off in the fourth stage. The number, rated capacity, injection volume, and expansion time of embedded expanders were recorded. The occurrences of complications including infection, hematoma, ulceration of expanded flap after the first stage operation, and blood supply disorder or necrosis of flap after operation in the second and fourth stages were observed. All the patients were followed up for 1 year at least, and the color of flap, scar of frontal donor site, symmetry of bilateral eyebrows, and the nasal appearance and ventilated function of external nasal tract were observed. Results A total of 26 expanders were embedded in 26 patients. The rated capacity of expanders ranged from 100 to 300 mL. The injection volume was 1.0 to 1.5 times of the rated capacity of expanders. The expansion time ranged from 2.5 to 4.0 months, with an average time of 3 months. There were no complications occurred after each operation. The follow-up showed that the color of flap was similar to the normal nasal skin, the scar of frontal region was not obvious, the bilateral eyebrows were basically symmetrical, the nose had excellent appearance, ventilation function of external nasal tract was not affected, while some of the patients had downward rotation or unapparent tip-defining point of nose. Conclusions Using the flip scar flap to reconstruct the nasal inner lining and pre-expanded frontal flap to reconstruct the nasal skin, without free cartilage transplantation to repair the partial nasal defects can achieve satisfied nasal appearance post operation, without abnormal external nasal ventilation function. -
Key words:
- Tissue expansion /
- Rhinoplasty /
- Forehead /
- Surgical flaps /
- Scar flap
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参考文献
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1 扩张后额部皮瓣联合翻转瘢痕瓣修复例1患者鼻尖及鼻翼缺损。1A.术前可见鼻尖及两侧鼻孔上穹隆缺失，两侧鼻翼部分缺损；1B.额部皮瓣预扩张术后2.5个月；1C.额部预扩张皮瓣带蒂转移术后3周，皮瓣血运良好，色泽与周围正常皮肤相近；1D.皮瓣断蒂术后1周，皮瓣血运良好，额部蒂部未用皮瓣还纳回额部供区；1E、1F.分别为Ⅳ期术后1年正、侧面照，再造鼻部分与正常鼻部皮肤色泽相近、衔接好，外鼻形态好；1G、1H.分别为Ⅳ期术后10年正、侧面照，重建鼻尖出现内旋表现
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