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。     

鼻部分缺损畸形的显微外科技术修复

目的探讨临床应用显微外科技术修复鼻部分缺损的方法。方法应用耳前和耳廓复合组织瓣供血的颞浅血管以旋股外侧血管搭桥与面动静脉吻合手术技术重建鼻部分组织缺损,供区采用耳后皮瓣转移一期修复。结果本组手术共修复28例不同部位的鼻部分缺损畸形病例。移植的耳廓复合组织瓣最大面积4.0cm×2.5cm,最小2.5cm×1.5cm,移植的血管桥长度最长14cm,最短10cm。27例手术获得完全成功,医患双方对再造的鼻形态和色泽均表示满意,其中7例得到术后3~6个月随访,并有3例进行了门诊二期组织瓣蒂部臃肿修整术。随访病例对结果满意。失败1例的原因可能与年龄和长期吸烟、高血压、血管硬化,导致复合组织瓣血液灌注不足有关。结论应用显微外科技术移植耳前和耳廓复合瓣再造鼻部分缺损效果可靠,外形结果满意,供区部位形象可以接受。     

基于鼻部美学亚单位鼻翼缺损修复术式的选择

目的参照鼻部美学亚单位的原则,根据鼻翼缺损的大小和毗邻亚单位的缺损,选择鼻翼缺损的修复术式。方法自2011年7月至2013年6月,我们共收治6例鼻翼缺损的患者。其中鼻翼亚单位缺损4例,行耳郭复合组织游离移植;鼻翼合并鼻尖亚单位缺损2例,应用显微外科技术,行逆行颞浅血管供血的耳前皮瓣游离移植,血管蒂与受区邻近的鼻唇沟处角动、静脉吻合。结果本组6例游离组织均成活,随访6～12个月,重建的鼻翼皮肤色泽与周边接近,弹性正常,瘢痕隐蔽。结论大于鼻翼亚单位50％的缺损,用耳郭复合组织游离移植修复;鼻翼合并鼻尖亚单位的缺损,用吻合血管的逆行游离耳前皮瓣修复。     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损

目的 探讨应用颢浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损的方法.方法 对16例鼻翼缺损患者,应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣移植修复.结果 全部病例移植的带蒂耳廓复合组织瓣完全成活,伤口一期愈合.最长随访4年,最短半年,移植的耳廓复合组织瓣的形态、颜色和质地与正常鼻翼相似,效果满意.结论 应用颞浅动脉蒂跨耳后动脉逆行岛状耳廓复合组织瓣修复鼻翼缺损,是一种理想的修复方法.     

Microvascular reconstruction of nasal ala using a reversed superficial temporal artery auricular flap.

Microsurgical technique allows successful transfer of an auricular flap in a one-stage procedure, using the root of the helix. Although a free composite auricular flap with the superficial temporal artery pedicle provides a good solution to repair nasal defects, its vascular pedicle is so limited that a vein graft from other area of the body is usually needed to reach the recipient site, leaving an unpleasant scar on the donor site. The authors present a reversed superficial temporal artery auricular free flap for alar reconstruction by microsurgical transfer. This technique has been performed on four patients with posttraumatic alar defects. In three patients, the reversed superficial temporal vessels of the flap were anastomosed directly with the recipient facial vessels in the nasolabial fold. In one patient, the reversed superficial temporal artery of the flap was anastomosed with the facial artery as above, its accompanying vein to the proximal stem of the superficial temporal vein by a graft taken from the excess length of the reversed superficial temporal artery pedicle because a suitable vein was not found for microvascular anastomosis in the nasolabial area. In these four patients, the size of the flap was 2.5 x 2.0-4.0 x 2.5 cm, the length of the vascular pedicle is 5-8 cm, average 6.5 cm. The reversed superficial temporal artery auricular flap offers a long vascular pedicle of the auricular free flap for microvascular anastomosis in the reconstruction of the ala of nose, delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. There is no need of vein graft from other parts of the body because the superficial temporal vessels on the temple provide not only the flap pedicle but also a source of vessel grafts. This technique may have even wider applications in other facial cutaneous defect.     

颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣修复鼻翼缺损

目的:探讨颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣在修复鼻翼缺损中的应用。方法:根据反流轴型皮瓣原理,设计以颞浅动脉为供血的岛状耳廓复合组织瓣,经皮下隧道转移修复鼻翼缺损。结果:本组8例患者,7例全部成活,术后随访6～30个月,移植物的形态、色泽与正常鼻翼组织相似,效果良好。1例移植的岛状耳廓复合组织瓣表皮及部分软骨坏死。结论:颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣修复鼻翼缺,是一种较为理想的修复方法。     

Reconstruction of the ala of the nose using a composite free flap from the pinna

A new method of reconstruction of the nasal ala is described using a composite free flap taken from the anterior part of the pinna, based upon the superficial temporal vessels. Forty cadaver dissections have been performed to assess variations in vascular anatomy and a direct branch of the superficial temporal artery was found in 90% of subjects. The flap has been used successfully in two cases.     

保留耳前鬓角形态并预防脱发的颞颊部除皱术

目的:介绍一种保留耳前鬓角形态并且预防术后脱发的颞颊部除皱术式。方法:颞部切口位于发际缘后方5cm左右并与鼻唇沟平行,耳前切口位于鬓角后缘。颞部于颞浅筋膜深面剥离至发际缘,切开颞浅筋膜于其浅面剥离至眼轮匝肌浅面。耳前于表浅肌肉腱膜浅面剥离至咬肌前缘。垂直于颞部切口向外上方悬吊颞浅筋膜,垂直于鼻唇沟向外上方悬吊腮腺浅面的表浅肌肉腱膜。结果:2008年以来应用该法治疗颞颊部面部老化患者24例,效果满意,未发生严重并发症。结论:该术式保留了耳前鬓角的自然形态,术后切口瘢痕隐蔽,无明显脱发,避免了重要神经、血管的损伤。     

Peroneal perforator‐based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft‐tissue defect of the forearm: A case report

We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43‐year‐old man had his left arm caught in a conveyor belt resulting in a large soft‐tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow‐through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow‐up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects.     

The chondrocutaneous ear helical free flap for the reconstruction of the defects of the nasal tip, columella and/or ala

Reconstruction of the full-thickness defect of the tip of nose, columella, and ala has always been a challenge. Local flaps can be used, but this often results in a bulky nose with an unsatisfactory aesthetic appearance requiring secondary surgical procedures. The use of the ear as a donor site for a microvascular free flap, although not general consensus despite structural similarities between the nose and ear, offers a possibility of a good reconstruction for such patients. Five patients presented with composite tissue defects of the tip, columella and ala of the nose resulting from human bites. Reconstruction was performed early in order to avoid possible infection. The free flap was designed and elevated from the upper part of the helix and concha of the opposite ear; the flap matched the traumatic defect on the nose and was based on the anterior auricular branches of the superficial temporal vessels. The free flap was brought to the defect and sutured to the margins. Direct end-to-end anastomosis of both vessels was performed in four patients while a venous grafts was needed in one patient. The donor flap area was closed directly. The follow-up period ranged from six months to five years. The reconstruction was satisfactory as to contour, symmetry and colour match in four patients. The final aesthetic result was obtained by touch-up procedures under local anesthesia. The donor site deformity was minimal. In one patient, the free flap was lost due to venous thrombosis and late reintervention. The chondrocutaneous free flap represents a dependable vascularized composite tissue transfer that offers a straightforward one-stage reconstruction of tissue defects of the tip, columella, and ala of the nose. The additional advantages of freedom in the flap design and structural similarity between the nose and ear makes it an ideal choice for such defects.Presented at the 5th EURAPS Meeting, Geneva, Switzerland, May 13, 1994     

Nasal alar reconstruction using a reverse composite island flap

Summary As a new nasal alar reconstruction method, a reverse composite island flap, based upon the superficial temporal artery has been performed. The flap consists of the anterior part of the helix. The use of such a flap also enables the concurrent reconstruction of the entire ala of the nose without the need for microsurgery. This paper describes the surgical technique involved and the usefulness of this flap in future applications.