双叶皮瓣修复鼻尖肿物切除后软组织继发缺损45例临床分析

目的 观察双叶皮瓣修复鼻尖部继发皮肤软组织缺损的临床疗效。方法 2015年1月—2020年1月解放军总医院皮肤科门诊45例鼻尖肿物切除后继发皮肤软组织缺损患者,鼻尖部继发组织缺损面积约1.0 cm×1.0 cm～2.0 cm×2.0 cm大小。于缺损周围正常皮肤设计双叶皮瓣,用双叶瓣的小叶修复大叶缺损,将大叶旋转、推进修复鼻尖肿物切除后继发的组织缺损。结果 45例患者术后皮瓣全部成活,仅1例术后切口轻度感染,经换药治疗后达Ⅰ期愈合,无皮瓣坏死等并发症发生。术后随访3～24个月,瘢痕轻微,鼻部形态完整,效果满意。结论 双叶皮瓣是修复鼻尖肿物切除后继发缺损的理想方法,手术风险小,患者满意度高。     

巨大皮角一例

患者女,92岁。因右颜部杏仁大无痛性肿物2年余,近2个月无明显诱因肿物显著增女夹诊。检查:一般状况欠佳,体质瘦弱。     

原发性结节型皮肤淀粉样变病1例

患者女,29岁。鼻尖部黄红色结节斑块1.5年。皮肤科检查:鼻尖部黄红色斑块,2 cm×2 cm大小,表面光滑,其上有丘疹、结节、毛细血管扩张,部分萎缩,边界清晰,质韧,无触痛。皮肤组织病理检查:表皮萎缩变薄,真皮全层大片无结构红染团块状物质,沉积物边缘及血管周围可见浆细胞浸润。结晶紫染色、刚果红染色(+)。诊断:原发性结节型皮肤淀粉样变病。     

皮肤混合瘤1例

临床资料患者女,54岁.因右鼻唇沟无痛性肿物2年,逐渐增大来诊.右侧鼻唇沟处可见0.6 cm×0.6 cm×0.5 cm无痛性肿物,单发,表面光滑无破溃,呈暗褐色,质软,基底较宽,不移动.     

皮肤行为症一例

临床资料 患者，女，18岁。主因右手指部出现皮肤无痛性斑块2年于2011年10月2日就诊。2年前患者发现其右手指部先后出现3枚大小不等的斑块，无瘙痒和疼痛，否认家族中有患相同疾病者。     

带蒂皮瓣修复头皮鳞状细胞癌切除后创面7例

1临床资料7例中,男5岁,女2例,年龄28~46岁,平均37岁;病程2个月~3年。病变部位:额顶部3例,颞顶部2例,枕部2例。皮损3cm×4cm~10cm×12cm大小,其中有2例合并有皮肤破溃及颅骨缺损,缺损区硬脑膜下可见胞搏动,边缘不齐,伴脓性分泌物渗出。切除肿物均经组织病理检查确诊为磷状细胞癌。2治疗方法对皮损局部清创,减少脓性分泌物。在全麻下肿物摘除术范围:肿物周边1.5cm处均切除,如有颅骨、硬脑膜癌肿浸润同时行转肿物切除术,并根据创面的位置、形状、大小取邻位带蒂皮瓣转移覆盖创面,供瓣区选大腿部中厚皮片移植。术后用无菌敷料加压包扎,必要时橡…     

皮肤混合瘤1例

临床资料 患者女,54岁。因右鼻唇沟无痛性肿物2年,逐渐增大来诊。右侧鼻唇沟处可见0．6cm×0．6cm×0．5cm无痛性肿物,单发,表面光滑无破溃,呈暗褐色,质软,基底较宽,不移动。     

不同诱因导致面部皮肤炎性肌纤维母细胞瘤二例

例1女,72岁,主因左面部皮肤硬化1年、加速生长1个月入院.追溯病史,1973年患者不明原因发热伴鼻塞2个月,检查发现左下鼻甲肿物,病理报告为未分化癌.给予X线照射鼻两侧(照射剂量:0.557～0.645 C/kg)及左鼻腔(照射剂量:1.032 C/kg),共治疗78 d.出院后患者鼻腔干燥,左下鼻甲与鼻中隔粘连,双侧鼻腔黏膜苍白,X线照射区色素沉着.继续X线照射左鼻腔(照射剂量:0.637 C/kg)近1个月,照射部位皮肤明显发红.2005年患者鼻尖部肿物2个月,扩大切除局部植皮术后病理报告为基底细胞癌,术后未做放射治疗.     

马尔尼菲青霉病致溶骨性损害2例

例1患者女,54岁,反复咳嗽、咳痰11月,再发加重1月入院,住院期间患者全身皮肤突然出现多个紫红色大小不等的结节,发热,因外力致左肩部疼痛,活动受限;例2患者男,43岁,因反复发热、颈部肿物1年,右上臂疼痛13天入院,因外力致右上臂活动受限;以上2例经组织及脓液培养均确诊为马尔尼菲青霉病,X线片提示2例骨折均为病理性骨折。     

结节性原发性限局性皮肤淀粉样变一例

<正> 结节性原发性限局性皮肤淀粉样变(NPLCA)是一种罕见的皮肤病,国内文献未见报道。作者最近见到一例。报告如下。患者,女,56岁,农民。8个月前在鼻尖部发现一栗粒大红色丘疹,自觉无不适,逐渐发展占鼻尖大部,高出皮面。系统检查未发现异常。皮肤科情况:鼻尖部有一直径为1.5cm的园形斑块,边界清楚,无压痛,     

应用三叶皮瓣修复鼻尖部皮肤缺损

目的 探讨应用三叶皮瓣修复鼻尖部皮肤缺损的经验与体会。 方法 23例鼻尖部肿瘤手术切除后皮肤缺损患者,缺损面积1.5 cm × 1.5 cm ~ 2.5 cm × 2.5 cm。根据创面的位置及大小,设计三叶皮瓣进行修复,各瓣叶之间的角度保持在45° ~ 50°,第1个瓣叶与创面的大小相等,第2、3个瓣叶依次缩小,修复过程中尽量保持鼻部美容亚单位的完整性,并利用天然皱褶隐藏瘢痕线。 结果 23例的皮瓣术后全部成活,切口Ⅰ期愈合。23例术后随访6个月至2年,皮瓣与周围皮肤组织的色泽、质地及厚度相近,切口瘢痕隐蔽,鼻翼、鼻孔、鼻小柱及周围器官均未发生畸形,形态满意,功能良好。 结论 三叶皮瓣能有效修复鼻尖部较大面积皮肤缺损并取得良好的形态与功能效果。     

Reconstruction of the nasal tip using a nasalis myocutaneous flap

Reconstruction of nasal tip defects is a technical and aesthetic challenge for dermatological surgeons, due to the limited reservoir of available skin and its thick, inflexible nature. The myocutaneous flap described in this paper, using the vascular pedicle of the transverse nasalis muscle, is an excellent option for repair of defects of the nasal tip. It provides a cosmetically superior result to skin grafting, particularly in noses of 'sebaceous' quality, by providing similar local skin. The flap maintains normal nasal tip contour and, being an axial pattern flap, its blood supply is reliable.     

The use of perichondrial cutaneous grafts to repair defects of the lower third of the nose

The reconstruction of surgical defects on the nasal tip and nasal ala which require both skincoverage and underlying support is often a complex surgical problem. The perichondrial cutaneous graft (PCCG) is a composite graft of skin and perichondrium harvested from the conchal bowl of the ear. It is an excellent alternative to full-thickness skin grafts and local flaps for reconstructing defects of the lower third of the nose. This composite graft, which is composed of epidermis, dermis, a small amount of subcutaneous tissue, and the underlying perichondrium, yields excellent cosmetic and functional results in a simple, single-stage, out-patient procedure. This article describes and illustrates the repair of surgical defects on the nasal tip and nasal ala using the PCCG.     

Comparative Measurement of Biophysical Parameters in Consideration of Skin Graft Donor Site for Nasal Defects

BackgroundIn planning a skin graft, the texture, color, and size of the recipient and donor site tissues should be considered.ObjectiveWe determined the optimal donor sites for nasal full-thickness skin grafting based on biophysical parameters.MethodsThirty women over the age of 60 were selected for this study. Four recipient sites (nasal root, dorsum, tip, ala) and three donor sites (preauricle, postauricle, forehead) were considered. Biophysical parameters such as transepidermal water loss (TEWL), capacitance, sebum output, erythema/melanin value, and skin replica technique were tested.ResultsThe nasal root was correlated with the forehead in terms of TEWL and sebum output. The nasal dorsum was correlated with the preauricle in terms of TEWL, erythema/melanin value, and skin replica measurements. The nasal tip was correlated with the preauricle in terms of TEWL, sebum output, erythema/melanin value, and skin replica measurements. The ala was correlated with the forehead in terms of TEWL and skin replica measurements.ConclusionThe preauricule is the optimal donor site for resurfacing of the nasal dorsum and tip. The forehead is a good donor site for alar defects. For resurfacing of the nasal root, the forehead and postauricle are good choices.     

A dorsal nasal advancement flap for off-midline defects

BACKGROUND: The repair of nasal tip defects often poses a challenge as many of the commonly used techniques for repair of the distal nose can result in obvious scars, mismatched skin, or distortions of the nasal contour that can compromise the aesthetic outcome. OBJECTIVE: Our aim was to create a novel nasal tip flap and examine outcomes of its use. METHODS: The dorsal nasal advancement flap was studied in 30 patients. RESULTS: All patients had good to outstanding results and no complications. CONCLUSION: This new flap, a modified Burow's advancement flap adapted to the nasal tip, provides an alternative to full-thickness skin grafts and transposition, rotation, and pedicle flaps for repair of the distal nose that is easy to execute and has optimal aesthetic results.     

The axial frontonasal flap for reconstruction of large nasal-tip defects based on modified nasal subunits in East Asians

The nasal tip is a prominent landmark on the face, and skin carcinomas of this area are very common. Moderate and large deep skin defects of the nasal tip normally represent a difficult reconstructive challenge. Nasal-tip reconstruction techniques have evolved to allow not only filling of the gap, but cosmetic and functional retention. Numerous flap options are available to reconstruct the defect of the tip of the nose. In this paper, we report the technique of the axial frontonasal flap and its use in reconstruction of large nasal-tip defects in East Asians. The axial frontonasal flap described is a good alternative for reconstruction of nasal-tip defects > 15 mm in diameter, with excellent aesthetic results. This technique is reliable, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defects of the nasal tip.     

Island composite nasal flap for nasal dorsum skin defects

Background  Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects.
Methods  During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months.
Results  In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor.
Conclusions  The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.     

A "skin helix" flap to correct circular skin loss on the nasal ala

The surgical treatment of circular skin defects localized on the nasal ala is always extremely challenging. Such lesions can be repaired by using full-thickness skin graft or skin flaps, normally with poor aesthetic outcomes. Skin grafts do not achieve satisfactory aesthetic results because of the unnatural look of the transplanted skin. If a skin flap is chosen, the choice of which one to employ among the many available must be made very carefully in order to obtain the best possible aesthetic outcome. This article describes the clinical case of a localized tumor on the nasal right ala that was surgically removed and satisfactorily treated by employing a "skin helix flap."     

Success in the use of oral propranolol in the treatment of infantile hemangioma in nasal tip – Report of two cases

Infantile hemangioma is the most common pediatric vascular tumor, with the following risk factors: low birth weight, prematurity, white skin, female gender, multiparity and advanced maternal age. The use of oral and topical beta-blockers, although recent, has emerged as the first line of treatment, with superior safety and efficacy to previously used therapies, such as corticosteroids and surgeries. This report describes two cases of nasal tip infantile hemangioma, treated with oral propranolol. Both presented excellent therapeutic responses.     

Using the Peng flap for a wide dorsal nasal defect

Reconstructions of large surgical defects of the central part of the nose pose a challenge for the surgeon due to its cosmetically prominent location. Treatment options include second intention healing, full‐thickness skin grafts and various local flaps. In the present case the “Peng flap” was used for the reconstruction of a 3.1 × 7 cm sized deep defect of the convex curve of the central nasal area in a 66‐year‐old woman. The Peng flap was performed as single‐stage procedure without complications. Good cosmetic outcome was provided by the use of adjacent skin from the lax perinasal area, the placement of the scar lines between facial cosmetic units, and the excellent tissue match for the sebaceous nasal skin. Considering the few complications of a single‐stage procedure associated with an excellent aesthetic outcome, the Peng flap should be considered not only as an effective choice for reconstruction of the cosmetically complex midline nasal tip but also the convex curve of the central nose.