吻合血管的逆行游离耳前皮瓣移植修复鼻部分缺损

目的旨在设计以颞浅动脉远端为蒂的逆行游离耳前皮瓣进行吻合血管的移植一期修复鼻部分缺损。方法本组共3例,1例为鼻尖缺损,1例为右侧鼻翼缺损,1例为鼻尖缺损、右侧鼻翼完全缺损及左侧鼻翼不完全缺损。术中将游离逆行耳前皮瓣的颞浅动、静脉分别与鼻唇沟部面动、静脉吻合,其中1例急诊患者颞浅静脉是与下睑伤口的一条静脉吻合。结果逆行游离耳前皮瓣大小范围为3.0 cm×2.5 cm~6 cm×2 cm,血管蒂长5~6 cm。3例患者皮瓣均成活,再造的鼻尖、鼻翼外形逼真,皮肤色泽、质地与鼻部皮肤接近。耳前供区切口隐蔽不遗留明显瘢痕。结论耳前皮瓣皮肤颜色、质地与鼻部接近,皮瓣血管蒂长,不需要血管移植,可通过显微外科技术一期修复鼻部分缺损,该皮瓣也可用于面部其他皮肤缺损的修复。

Reconstruction of nasal defects using a reverse preauricular flap by microsurgical technique

OBJECTIVE: This article reports the design and application of a free reverse preauricular flap for one-stage reconstruction of nasal defects. METHODS: A preauricular flap was designed according to the nasal defect, which was harvested with the reverse superficial temporal vessels as its vascular pedicle. The flap size ranged from 3.0 cm x 2.5 cm to 6 cm x 2 cm without any hair-bearing skin. In flap transferring, its pedicle of the superficial temporal vessels was anastomosed with the facial vessels in the nasolabial fold. RESULTS: The flap survived uneventfully in these three patients. The defects in the distal nose were reconstructed with satisfactory results. The donor site scar was similar to that of face-lift incision. CONCLUSIONS: This is the first report of clinical applications of the free reverse preauricular flap by microsurgical technique. Microsurgical technique allows successful transfer of this flap in a one-stage procedure. Because of its similar color and texture to the facial skin, this flap provides excellent tissues for coverage of the nasal defect. This technique may have even wider applications for other facial cutaneous defects.