Complex partial nasal reconstruction using free prelaminated temporoparietal fascial flap

The reconstruction of nasal defects together with nasal lining, skeletal support, and skin loss constitutes difficulty to plastic surgeons. We present a single‐stage reconstruction of the defect formed on the nasal tip, columella, septum, and upper lip after tumor excision by performing free temporoparietal fascial flap, costal cartilage, and skin graft. In this case, cartilage support was created by the graft taken from costal cartilage, and free temporoparietal fascial flap was wrapped around this cartilage scaffold. Skin graft taken from scalp was placed on the skin surface, and skin graft taken from the thigh was placed on the mucosal surface. Vascular anastomoses were performed on the labial artery and the concomitant vein. In consequence of this operation, a nasal reconstruction with acceptable esthetic and functional results was provided in a complex nasal defect. Internal lining, skin, and cartilage structures were replaced in one single stage and with single flap and graft. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

扩张额部颞浅血管蒂皮瓣修复鼻部分缺损

目的在传统额部皮瓣的基础上,探索以减少传统的方法继发额部瘢痕的鼻部分缺损的修复方法。方法手术分两期进行。Ⅰ期将100～150ml的软组织扩张器置入鼻缺损同侧额部皮下的颞浅血管额支的深面。Ⅱ期将扩张后的皮肤,根据鼻缺损的形状和大小,切取以颞浅血管额支为蒂的额部皮瓣修复鼻缺损。供区创面直接缝合在额颞部的发际缘。结果自2003年7月至2006年11月,采用此皮瓣修复鼻一侧的全层缺损的患者7例,手术全部成功。术后随访患者3～6个月,鼻形态较好,供区无明显的继发瘢痕。结论扩张额部颞浅血管蒂额部皮瓣是修复鼻部分缺损的一种较理想的皮瓣,此手术方法可有效地改善传统的方法继发的额部瘢痕。     

Endoscopic-assisted harvest of the temporoparietal fascial flap

Elevation of the temporoparietal fascial flap by conventional T or Y incisions in the temporal region frequently leaves conspicuous scarring, hair thinning, or baldness. To avoid such undesirable effects, endoscopic-assisted harvest of the temporoparietal fascial flap was performed in 9 patients with microtia. Through two horizontal incisions in the temporal region, the temporoparietal fascia was dissected, and the flap was harvested using bipolar scissors and coagulating shears. Flaps were dissected and harvested successfully without any complications in 7 patients, although extra incisions were required to facilitate coagulation in 2 patients. The authors introduce this harvesting technique and describe some representative cases. Using endoscopic guidance, this is a versatile, safe procedure with minimal morbidity, and is applicable to other reconstructive procedures that require a temporoparietal fascial flap, including the free flap.     

Secondary reconstruction by temporoparietal free fascial flap for ring avulsion injury

We report the secondary reconstruction of an amputated finger following a ring avulsion injury using a temporoparietal fascial flap (TPFF). There have been reports of preserving degloved fingers using a cross-finger flap and an abdominal flap, but it is difficult to obtain good results with these procedures. The TPFF is an ideal, thin flap that gives excellent results, preserving movement of the phalangeal joint.     

滑车上血管蒂额部皮瓣转移鼻再造术

目的探讨改进额部皮瓣的设计及转移方式行Ⅰ期鼻再造术。方法通过颈内、外动脉造影的影像学资料观察额部血供来源及分布情况,设计以一侧滑车上血管为蒂的额部不同部位皮瓣行鼻再造。额部存在多源性血供,滑车上动脉、眶上动脉于额骨眉突平面发出多条分支,颞浅动脉额支可见1条恒定、较粗大的水平分支,向额中部延伸,上述3条血管分支构成了额部丰富的肌层、皮下组织层血管网,呈立体分布。利用一侧滑车上血管为蒂分别切取同侧或对侧额部皮瓣,共行鼻再造术9例。结果9例受术者皮瓣完全成活,再造鼻形态、功能均满意。结论以滑车上血管为蒂设计的额部跨区供血的皮瓣血运丰富,瓣远端分离出的肌筋膜瓣可以较好地包裹软骨支架,同时分离后的皮瓣更利于塑形,可以满足鼻再造的需求。     

颞浅筋膜瓣联合中厚植皮法修复外耳再造术后软骨支架外露

目的 探讨外耳再造术后出现皮瓣坏死、软骨支架外露后,应用颞浅血管为蒂的颞浅筋膜瓣联合中厚皮片植皮的方法进行修复的效果.方法 沿颞部发际内行垂直切口,以颞浅血管为蒂,沿颞肌筋膜表面剥离,形成颞浅筋膜瓣,向下旋转包裹支架外露部位,筋膜瓣表面行游离中厚皮片移植,术后给予抗感染治疗3d.结果 10例患者术后伤口均愈合良好,无支架外露、皮片坏死现象.随访3～12个月,其再造耳耳轮、对耳轮、三角窝等表面结构清晰,有明显的立体形态,不显臃肿,效果满意.结论 对外耳再造术后出现软骨支架外露,利用颞浅筋膜瓣联合游离移植中厚皮片法可获得较满意的修复效果.     

筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损

目的：探讨筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损的方法及疗效。方法：2010年10月～2012年6月，笔者单位应用筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损患者共23例．男16例，女7例。年龄16～46岁，以中青年务工者居多。左侧10例．右侧13例，挤压毁损伤6例，撕脱伤8例，电锯伤9例：伤情均为拇指末节指骨或肌腱外露，皮肤软组织缺损。结果：术后除1例皮瓣远端血运不佳经换药创面愈合外，其余皮瓣全部成活，术后外形及功能良好，术后均有触、痛、温觉，患者均较满意。结论：筋膜血管神经蒂食指背皮瓣修复拇指缺损具有操作简单，手术一次完成，不需细小血管吻合技术，不需特殊设备，术后外形美观等优点。是年轻医生急诊处理拇指缺损的的理想方法。     

额部阶梯状皮瓣与肌、皮双瓣鼻再造术

目的　改良目前常用的额肌皮瓣鼻再造术 ,克服其形态臃肿 ,再造鼻高度受限等不足 ,进一步提高手术效果。方法　根据新观察到的滑车上动脉于眉上存在一相同走向的皮支的解剖特点 ,设计额部阶梯状皮瓣与肌、皮双瓣 ,前者用于克服肌皮瓣臃肿 ,再造鼻形态欠佳的缺点 ,一次成形鼻各组成结构。后者组成结构肌瓣用于构建鼻中隔结构 ,适用于复杂病例 ,并可增加再造鼻高度。结果　 9例患者术中均可见滑车上动脉于眶缘上 1 2～ 1 7cm开始有皮支行于皮下 ,且与对侧有交通支。术后皮瓣全部成活 ,其中 1例鼻小柱右侧支架外露 ,经二次手术修复痊愈。鼻各组成结构塑形良好。结论　额部阶梯状肌皮瓣和肌、皮双瓣适用于修复不同程度的鼻缺损 ,再造鼻形态较好 ,可为鼻再造的首选方法。     

扩张的额部复合皮瓣预制法鼻再造术

目的：探讨一种应用扩张的额部复合皮瓣预制进行鼻再造的手术方法。方法：2008年7月～2010年1月,对7例鼻缺损患者分四期行鼻再造术。一期：埋植额部扩张器,同时额部皮下移植自体软骨,额肌深面中厚植皮;二期：取扩张器,行额部扩张复合皮瓣转移鼻再造术;三期断蒂;四期修整。结果：7例患者手术后随访6～12个月,手术均取得较好的效果。结论：扩张的额部复合皮瓣预制法鼻再造术为修复鼻全层缺损提供了一种新的术式选择。     

应用改进的额部扩张皮瓣行全鼻再造术

目的 探讨应用改进设计的额部扩张皮瓣行全鼻再造术的效果。方法 将前额主要供血支部分结扎阻断，保留选用的轴型血管蒂，强化皮瓣扩张的延迟效应，除设计以额正中皮瓣做全鼻再造外，还选用额上区横向扩张皮瓣，其供区缺损施以同侧或对侧扩张皮瓣推进修复，直接缝合。共已应用11例。结果 11块额部扩张皮瓣转移后完全存活，随访6个月～8年4个月，再造鼻功能形态恢复满意，供区瘢痕不明显。结论 强化额部扩张皮瓣血供或选用额上区横向皮瓣都是鼻再造的有效方法。     

应用额部皮瓣修复前额皮肤缺损

目的:应用额部皮瓣修复前额皮肤缺损。方法:根据前额缺损情况,利用眶上动脉及滑车上动脉为蒂的额部转移皮瓣进行修复。结果:本组5例前额皮肤缺损,缺损范围2cm×2cm～6cm×4cm,皮瓣全部成活,切口Ⅰ期愈合,1例供瓣区植皮部分坏死,经换药后愈合。随访观察2月～12月,皮瓣色泽正常,存在感觉,额部外观及功能恢复满意。结论:额部皮瓣血管走行恒定、表浅、血运丰富、易于解剖,切取损伤小、是修复前额皮肤缺损的好方法。     

Bitemporal flap reconstruction of forehead.

The bitemporal flap meets the increasing demand for esthetic reconstruction of forehead defects. The surgical technique, applied anatomy, and plastic surgery principles are reviewed. Illustrative case histories review the application of the bitemporal flap reconstruction technique.     

颞顶筋膜瓣在修复外耳再造术后支架外露的应用

目的：探讨应用颞浅血管为蒂的颞顶筋膜瓣在外耳再造术后支架外露后进行修复的效果。方法：根据软骨支架外露形状,设计颞浅血管为蒂的颞顶筋膜瓣旋转包裹外露支架,加游离移植中厚皮、抗感染治疗。结果：8例患者术后再造耳支架外露修复效果良好,再造耳外形无明显改变。结论：外耳再造术后如发生再造耳皮瓣破溃、软骨支架外露的并发症,选择颞顶筋膜瓣旋转包裹外露支架,加游离移植中厚皮、抗感染治疗的治疗方法,可获得较满意的修复效果。     

逆流颞顶筋膜瓣翻转修复顶额部缺损

目的 研究逆流颞顶筋膜瓣悉转移转术及临床应用效果。方法 根据颞浅动脉颞顶分支与耳后,枕动脉支,前额分支与眶上,滑车上动脉支有丰富吻合或与对侧主要血管支直接交通,构筑跨区供血的解剖学基础,设计以颞浅动脉轴型血管及其吻合支为蒂的逆流颞顶筋膜 瓣,向顶枕侧或前额顶部移转覆盖充填骨外露缺损区,表面行皮片移植术,结果,自1996年11月始,临床已应用7例,最大筋膜瓣13cm*7cm,术后筋膜瓣及植皮区完全存活,外形较为满意,癌肿病例术后3周接受放射治疗。结论 逆流供血的颞顶筋膜瓣血运可靠,是顶额枕部深度组织缺损即期,简便,有效的修复方法。     

The pedicled superficial temporalis fascial flap: a new method for reconstruction in otologic surgery.

OBJECTIVES: Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery. METHODS: The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures. RESULTS: No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow-up ranges from 2 to 25 months. CONCLUSIONS: This fascial flap provides a wide surface area of tissue on a narrow-based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.     

Expanded forehead flap for reconstruction of the nose

Eight cases of reconstruction of nose by using skin expander are reported in detail in this article. In which, 6 cases were total nose reconstruction, 2 were upper partial reconstruction. The results were good in all cases. It is considered that the forehead flap is the place of choice in nasal reconstruction. It gives good shape contour and best color match. After application of tissue expander it could provide more skin for reconstruction, and prove more advantages in repairing the donor site. It has been observed that the reconstructed nose contour was satisfactory, with no obvious constriction after more than a year follow up. The methods and advantages of operation and some typical cases are presented.