鼻再造术中衬里组织的修复方法

目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。     

鼻美学亚单位分区在鼻端缺损修复中的应用

目的 探讨应用鼻美学亚单位分区原则修复鼻端缺损的方法和临床效果.方法 以鼻美学亚单位为基础,将鼻端缺损部位周围的正常皮肤或瘢痕皮肤翻转作为衬里,废弃亚单位区域内其余正常皮肤组织,以额部皮瓣覆盖鼻端亚单位的皮肤缺损.自2000年8月至2011年7月,修复鼻端皮肤软组织缺损患者10例.结果 本组10例患者创面均Ⅰ期愈合,术后随访 1～18 个月,鼻外形轮廓良好,受区皮肤组织在色泽、质地等方面与周围皮肤匹配良好.结论 按照鼻美学亚单位分区来修复鼻端缺损,能获得满意的功能和美学效果.     

颞浅血管蒂额部岛状皮瓣修复鼻部分缺损

目的　研究颞浅血管蒂额部岛状皮瓣修复鼻部分缺损的方法。方法　自 1992年以来采用颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 17例 ,全层缺损以皮瓣远端折叠法或局部翻转皮瓣法制作衬里。皮瓣最小面积 1.5cm× 3cm ,最大面积 8cm× 10cm。结果　 17例中 ,移植皮瓣完全成活 12例 ,经随访 1～ 11年 ,鼻缺损修复后轮廓形态逼真 ,移植皮瓣颜色和周围肤色差别小 ,外形和功能良好。皮瓣供区痕迹不明显。移植皮瓣回流障碍 3例 ,术后局部遗留色素改变。移植皮瓣部分坏死 2例 ,皮瓣部分坏死后 3周 ,用对侧鼻唇沟带蒂皮瓣移植修复。结论　颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 ,是一种良好的选择。     

应用额部皮瓣三期法修复外伤后鼻缺损

目的 探讨应用额部皮瓣三期法修复外伤后鼻缺损的方法及效果.方法 自2004年6月至2010年10月,对6例外伤后鼻缺损患者分三期进行修复.Ⅰ期急诊清创,设计切取额部旁正中皮瓣,远端带毛发部分折叠后修复鼻衬里,近端修复外面的皮肤缺损,蒂部裸露创面及额部供区取中厚皮片移植修复;Ⅱ期将皮瓣近端掀起,切除皮瓣下额肌及部分皮下脂肪行皮瓣削薄,再取耳甲软骨移植修复软骨缺失,最后将皮瓣缝回至原位;Ⅲ期行皮瓣断蒂,蒂部回纳至额部及皮瓣近端削薄修整.结果 6例患者的皮瓣完全成活.术后随访4个月至2年,鼻部瘢痕不明显,其中鼻外形功能良好者4例,皮瓣与鼻残余皮肤色差较明显者1例,再造鼻翼缘有稀疏毛发生长者1例.结论 额部皮瓣三期法简单易行,用于修复外伤后鼻缺损可取得外形及功能均较满意的效果.     

利用鼻中隔粘骨膜复合瓣修复半侧鼻下部衬里缺损的临床研究

目的:探讨一种半侧鼻下部全层缺损衬里修复的手术方法.方法:根据衬里缺损的面积,设计对侧相应大小鼻中隔粘膜软骨膜复合组织瓣,通过鼻中隔背部跨越鼻中隔软骨,将血运良好的复合组织瓣固定在缺损周边的骨膜上.对8例半侧鼻下部全层缺损患者采用此方法修复衬里,其中3例男性,5例女性,并同时运用局部皮瓣或额部皮瓣修复外层,耳软骨或肋软骨重建支架,随访6～12个月,了解鼻衬里恢复情况.结果:本组8例患者再造鼻衬里均血运良好,鼻腔大小及通气正常,鼻中隔形态正常,供区呼吸性上皮覆盖,无穿孔、感染或偏曲.结论:在半侧鼻下部全层缺损的衬里再造中,应用此方法进行衬里修复,组织性质最接近,血运好且薄,柔软且挛缩程度小,同时为软骨支架提供良好血供,保持了鼻部组织的完整及自然形态,是一种良好的鼻部衬里修复方式.     

从美学角度对额部扩张皮瓣行外鼻重建术的改进

目的 探讨从美学角度重建外鼻的手术方法及优点.方法 对12例鼻下端缺损行额部扩张皮瓣修复,在额部帽状腱膜下方斜向置入皮肤软组织扩张器,采用常规扩张法注液,以鼻背皮肤及鼻端残余瘢痕和黏膜作为衬里,测量患者鼻翼或内眦间距,在扩张的皮肤上以此为基准按美学标准设计三叶肌皮瓣,向下翻转再造外鼻,按美容亚单位分区修剪皮瓣至不同层面并塑形.结果 12例鼻缺损患者术后无一例皮瓣坏死,随访6个月至1年,鼻形态自然、美观.结论 从美学角度按个体化标准化设计的三叶肌皮瓣再造全鼻安全、理想.术中皮瓣的塑形、血运良好的鼻衬里、鼻支架的Ⅰ期置入也是鼻形态良好的关键.     

鼻缺损修复再造的美学原则探讨

目的探讨应用整形美容外科的手术原则修复再造鼻缺损畸形,提高鼻缺损畸形的美学修复效果.方法自1998年10月至2005年8月,根据患者鼻缺损的部位及范围,采用耳郭复合组织移植、鼻唇沟皮瓣、额部皮瓣、颞部皮瓣、耳后皮瓣、上臂远位皮瓣等方法修复各种缺损畸形,并综合比较分析手术的方法及效果.结果 98例鼻缺损患者获得良好的修复,畸形得到不同程度的改善.各种手术方法的效果存在一定差别.结论鼻缺损情况复杂多变,应根据缺损的部位、范围选择相应的修复方式,以达到最佳的美学修复效果.     

额部皮瓣在面颊部缺损修复中的应用

目的 报道额部岛状皮瓣在面颊部缺损修复中的应用. 方法 根据面颊部缺损的情况分别采用额部岛状皮瓣转移、局部组织翻转形成衬里加额部皮瓣转移、额部皮瓣内面植皮转移等方法进行修复. 结果 本组16例,缺损最大10 cm×6 cm,最小3 cm×2 cm.额部皮瓣转移修复颊部皮肤缺损7例;局部黏膜或皮肤翻转衬里加额部皮瓣修复皮肤缺损6例,额部皮瓣内侧植皮作为衬里3例.除1例额部皮瓣坏死及2例皮瓣远端部分表皮坏死外,余皮瓣成活良好,色泽正常,面颊部外形及功能恢复良好. 结论 额部岛状皮瓣血供可靠、血管蒂长、色泽良好、操作简单,是修复面颊部缺损的较好方法.     

通过鼻再造术一次性修复鼻及鼻周缺损

目的：探索一次性修复鼻及鼻周缺损的治疗方法。方法：1995年～2008年,收治34例鼻及鼻周缺损的患者,男21例,女13例;年龄17～70岁。先行额部扩张器置入术。二期手术,利用缺损周围的局部翻转皮瓣形成鼻衬里,将缺损纳入鼻前庭;额部扩张皮瓣移位行鼻再造术。三期断蒂。病程6～26月。结果：34例患者,32例疗效满意。结论：将鼻周的缺损视作术后新鼻部解剖区的一部分,再造全鼻并修复缺损,重建面部美学解剖分区。该方法与传统方法相比,能够获得更为满意的效果。     

鼻缺损修复再造的美学原则探讨

目的探讨应用整形美容外科的手术原则修复再造鼻缺损畸形,提高鼻缺损畸形的美学修复效果。方法自1998年10月至2005年8月,根据患者鼻缺损的部位及范围,采用耳郭复合组织移植、鼻唇沟皮瓣、额部皮瓣、颞部皮瓣、耳后皮瓣、上臂远位皮瓣等方法修复各种缺损畸形,并综合比较分析手术的方法及效果。结果98例鼻缺损患者获得良好的修复,畸形得到不同程度的改善。各种手术方法的效果存在一定差别。结论鼻缺损情况复杂多变,应根据缺损的部位、范围选择相应的修复方式,以达到最佳的美学修复效果。     

Total Nasal Tip Defect:Bilateral Lateral Nasal Artery Flaps for Lining Reconstruction

Background In full-thickness nasal defects,the internal lining is perhaps the most challenging aspect of the three layers to rebuild.Nasal damage is usually more concentrated on the tip,soft triangles,alar wings,and columella,but the lateral nasal arteries are often left intact and the damage to the dorsal sidewalls are normally superficial.Methods Twelve patients who required total nasal reconstruction received a forehead flap placement as external coverage and autologous rib cartilage as structural support.Residual normal/superficial scar tissue flaps on the dorsal sidewalls with lateral nasal artery pedicles were mobilized and designed for internal lining repair without creating secondary donor site damage.The flaps were then turned 180°downward and placed between the alar medial angles and the fornix.Results No total lining flap necrosis occurred in all the patients.Partial necrosis occurred on the distal edge owing to overpressure of the nostril splint to the flaps;however,the wounds eventually healed,and the nasal structural integrity was preserved.The patients were satisfied with the aesthetic results and had no complaints of airway stenosis.Conclusions Lateral nasal artery pedicle dorsal sidewall skin flaps are appropriately thick,providing enough nostril circumferential support to improve airway stenosis.It allows sufficient blood supply and creates no extra donor site damage.Blood vessels and skin flaps are often undamaged,thereby allowing maximum application in total nasal reconstruction.     

Complications Associated With Isotretinoin Use After Rhinoplasty

Background This study aimed to evaluate the association between the postoperative use of isotretinoin and the formation of nasal tip deformities after rhinoplasty.Methods A retrospective study investigated a case series of patients who presented with nasal tip deformities subsequent to the use of isotretinoin after rhinoplasty. Patients who had taken isotretinoin after rhinoplasty were identified from a single surgeon’s case log. Clinic charts and operative reports were reviewed. Predisposing factors and time intervals to complications were identified.Results Three patients were found to have undergone isotretinoin therapy after rhinoplasty. Nasal tip deformities included bossa formation, asymmetry, and prominence of a composite graft. All three patients required subsequent procedures to repair soft tissue nasal tip deformities. In all three cases, isotretinoin was started within 2 years of the primary rhinoplasty. The nasal tip deformities were first observed within 6 months after isotretinoin was started.Conclusions Three cases are described in which postoperative use of isotretinoin was associated with nasal tip deformities after rhinoplasty. Further studies are needed to investigate this possible causative relationship and to describe the risks involved.     

A combined therapy for the repair of alar defects that consists of a modified spiral flap and postoperative nasal stent

BackgroundThe repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.MethodsIn this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects.ResultsAll cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed.ConclusionOur preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.     

岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损

目的 介绍岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损的解剖学基础和3例临床实践。方法 根据解剖研究结果,设计以鼻懵基底动脉和神经为蒂的岛状鼻中隔软骨粘膜瓣,通过眶下区皮下隧道移转到眶区,修复缺损眼睑的结膜和睑板,结果 1998年至今共治疗3例,术后软骨粘膜瓣完全成活,无并发症发生。结论 岛状鼻中隔软骨粘膜瓣血运丰富,易成活,可提供足量的组织用以修复上、下睑或上和下眼睑结膜睑板的缺损,血管神经蒂长,移转灵活,使通过常规方法不能或难以修复的眼睑缺损得以修复,供区隐蔽,无明显继发畸形。     

Nasal lining flaps in contemporary reconstructive rhinoplasty

The advances that have taken place in the last decade in reconstructive rhinoplasty are based in strong major on the development of internal lining mucosal flaps used to resurface the interior of reconstructed full thickness nasal defects. This paper provides an in-depth analysis of these thin well vascularized flaps harvested from the remaining mucosa and vestibular skin of the nasal passage. They provide the foundation which is overlaid with cartilage grafts to replace skeletal support and covering flaps to resurface the grafts. This contemporary concept of layered reconstruction, replacing missing tissue with like tissue has revolutionized the approach to reconstructive rhinoplasty and has raised it to a higher level of sophistication resulting in enhancement in aesthetic and functional results.     

Combining rhinoplasty with septal perforation repair

A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.     

早期皮瓣修复治疗鼻整形术后感染致鼻组织缺损的效果

目的 分析早期皮瓣修复治疗鼻整形术后感染致鼻组织缺损的效果。方法 选取我院2020年 1月-2021年1月收治的20例鼻整形术后感染致鼻组织缺损患者为研究对象，对其开展早期皮瓣修复，术后 随访1年，观察患者的修复效果、修复满意度、负性情绪及生活质量。结果 20例患者的鼻部功能评分为 （9.22±0.33）分，质地评分为（8.98±0.41）分，轮廓评分为（9.04±0.30）分，色泽评分为（8.92±0.47） 分，修复满意度为100.00%；治疗后焦虑情绪评分、抑郁情绪评分均低于治疗前，差异有统计学意义 （P＜0.05）；治疗后心理功能、躯体功能、社会功能及物质生活评分均高于治疗前，差异有统计学意义 （P＜0.05）。结论 早期皮瓣修复治疗鼻整形术后感染致鼻组织缺损的效果良好，可有效改善患者的鼻部 功能、质地、轮廓及色泽，有利于减轻患者的不良情绪，提高其生活质量，值得临床应用。     

四种局部穿支皮瓣在鼻翼缺损修复中的应用

目的探讨4种局部穿支皮瓣修复鼻翼缺损的应用方法及临床效果。方法回顾性分析2015年6月至2018年6月安徽医科大学第一附属医院收治的41例各种原因导致的鼻翼缺损患者的临床资料,其中男22例,女19例,年龄15~93岁,平均45岁。鼻翼处缺损处面积为0.4 cm×0.4 cm^2.5 cm×2.5 cm,分别采用鼻唇沟角形穿支皮瓣(20例)、鼻翼基底穿支鼻唇沟岛状皮瓣(6例)、唇上-鼻唇沟角形穿支岛状皮瓣(5例)或鼻外侧动脉角形穿支皮瓣(10例)进行修复。术后对患者进行随访,观察鼻翼形态和鼻部功能,以及癌肿病例复发情况。结果41例皮瓣全部成活,皮瓣切取范围为0.5 cm×1.5 cm^4.0 cm×4.0 cm,鼻翼缺损完全修复,伤口均为一期愈合。术后所有病例均进行了4个月至1年的随访,术后鼻翼形态较好,鼻部功能未受影响,癌肿病例未见复发。结论鼻翼缺损面积较大时选用鼻唇沟角形穿支皮瓣,面部皮肤张力较大时采用鼻翼基底穿支鼻唇沟岛状皮瓣经皮下隧道修复,缺损邻近鼻唇沟处时宜用唇上-鼻唇沟角形穿支皮瓣,缺损面积较小时采用鼻外侧动脉角形穿支皮瓣修复。根据情况合理地选择皮瓣,均可获得较好的美学效果。     

The cascade flap for nasal tip repair

Summary A two flap repair of nasal tip and bridge defects is presented. The nasal bridge flap transposes down over the tip while a lower forehead or glabella flap hinges to the upper nose. These are random myocutaneous flaps and the design may be varied for different defects.