上臂皮管法修复鼻再造失败病例

目的 探讨针对鼻再造失败或效果不佳,且额部组织已完全破坏的病例,再次行全鼻再造的方法 。方法 自2008年1月至2010年1月,对3例鼻再造失败病例以上臂皮管法行全鼻再造。手术分四期进行。Ⅰ期:于左上臂内侧形成皮管(18 cm×8 cm);Ⅱ期:3周后切断皮管上端并转移至鼻根;Ⅲ期:3周后将皮管从上臂离断,形成皮瓣修剪成三叶状并向内折叠,以塑形成鼻翼、鼻尖和鼻小柱。同期取第7、8肋软骨,制成“L”形支架并固定;Ⅳ期:3周后进行断蒂修整。结果 3例患者均获成功,随访1~2年,再造鼻颜色、质地与周围皮肤较为匹配,外形及通气功能均达到满意效果。结论 对于额部组织已被破坏的鼻再造失败患者和坚决反对在额部留下任何痕迹的患者,采用上臂皮管行全鼻再造是行之有效的方法。

Repair of Failed Nasal Reconstructions by Using the Upper Arm Skin Tube Method

Objective To investigate amethod of repeated plastic reconstruction of the nose in patients after a failed or unsatisfactory initial reconstruction that totally destroyed the forehead tissue.Methods From January 2008 to January 2010, 3 cases with failed nasal reconstructions were repaired using the upper arm skin tube by four-stage.During StageⅠ,a skin tube was created using the internal aspectof the leftupper arm(18 cm×8 cm).During StageⅡ,which occurred three weeks after Stage I,the top end of the skin tube was severed and moved to the nasion.During StageⅢ,which occurred three weeks after Stage II,the skin tube was removed from the upper arm,forming a flap,which was trimmed to a three-lobed shape and folded inwards to construct the nasal alars,tip and columella.The seventh and eighth costal cartilageswere obtained to form an“L”-shaped scaffold.During StageⅣ,which occurred three weeks after StageⅢ,pedicle division and trimm ing were conducted.Resu lts The operation was successful in all three patients,and all the patientswere followed up for 1 to 2 years. The color and texture of the reconstructed noses were matched well to the surrounding skin,satisfactory appearance and ventilatory function were both achieved.Conclusion For patients with failed nasal reconstruction and destroyed forehead tissue or who are firmly against leaving amark in the forehead,the application of the upper arm skin tube for total nasal reconstruction is an effectivemethod.