The cascade flap for nasal tip repair

Summary A two flap repair of nasal tip and bridge defects is presented. The nasal bridge flap transposes down over the tip while a lower forehead or glabella flap hinges to the upper nose. These are random myocutaneous flaps and the design may be varied for different defects.     

以面动脉为蒂的逆行下颌缘皮瓣全鼻再造

目的　探讨全鼻再造术的新术式。方法　设计应用以面动脉为蒂的下颌缘皮瓣逆行移转行全鼻再造 6例。结果　 6例全鼻再造手术均一次完成 ,皮瓣一期成活 ,鼻外形满意。结论　以面动脉为血管蒂的全鼻再造 ,具有供、受区邻近 ,切取移转方便 ,血管恒定 ,血供丰富 ,技术要求不高 ,皮瓣质软与面部肤色近似等优点 ,并具有较好的应用价值。     

鼻再造术中衬里组织的修复方法

目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。     

Nasal tip repair with axial flap of nasal muscle

The procedure described here consists of a myocutaneous axial flap with lateral pedicle. It uses the transverse part of the nasal muscle that goes forward in rotation and the lateral and superior portions of the flap in the V-Y. The procedure is useful for repairing losses of nasal tip and the surrounding area. It is a simple method that can be used to reconstruct the brim near the tip of the nose, yielding an aesthetically and functionally efficient nose.     

A combined therapy for the repair of alar defects that consists of a modified spiral flap and postoperative nasal stent

BackgroundThe repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities.MethodsIn this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects.ResultsAll cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed.ConclusionOur preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.     

Three-Dimensional Nasal Reconstruction Using a Prefabricated Forehead Flap: Case Report

Surgical treatment is extremely difficult with the combined defects of skin, cartilage, and nasal mucosa. Besides efforts geared toward ascertaining the best aesthetic outcome, an important concern is restoring normal nasal function. This can be achieved only by providing sufficiently and anatomically adapted cartilage and bone support, followed by covering the inner part using tissue closely resembling mucosa and the outer part using skin compatible with the surrounding skin. The surgical technique for three-dimensional nasal reconstruction in the first session of this study involved placing a silicon sheet between the skin and galea, which allowed two separate flaps to be obtained for the next session without vascular damage. For the epithelialization of the defect on the nasal surface, the lower surface of the galea was prefabricated with a thin skin graft obtained from the thigh. In this way, nasal mucosa cover was ensured. The expander placed under all these structures thinned them down to a thickness close to that of nasal skin and mucosa and also enabled primary closure of the donor area. Thus, the defect that emerged during the second session in cartilage framework was repaired by cartilage grafts taken from the nasal septum. The mucosal surface and skin part then could be closed with two separate flaps. The forehead flap used in this technique enabled production of an aesthetically and functionally satisfactory outcome by providing an anatomically sufficient amount of nasal skin and nasal mucosa for whole-layer wide nasal defects in only three sessions without necessitating an additional flap.     

额鼻皮瓣在鼻尖部缺损修复中的应用

目的 介绍额鼻皮瓣在鼻尖部缺损修复中的应用经验.方法 在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状、深度,设计以内眦动脉分支血管为蒂的轴型额鼻皮瓣覆盖创面.结果 共施行手术21例,创面面积1.2 Gm×1.2 cm～2.0 cm×2.0 cm.术后皮瓣全部成活,无明显并发症发生.其中18例获得随访1～36个月,鼻外形轮廓较好,修复组织与周围皮肤匹配良好.结论 遵循鼻亚单位美学原则,应用额鼻皮瓣修复鼻尖部2.0 cm×2.0 cm以下创面,色泽、质地、轮廓等方面能达到较好的匹配和协调,可获得满意功能和美学效果.     

组织扩张器在额部皮瓣鼻再造术中应用探讨——临床报道10例

目的　减少扩张后的额部皮瓣再造鼻引起的严重继发挛缩 ,探讨组织扩张器在额部皮瓣鼻再造术中的应用。方法　对发际高的患者直接采用额部皮瓣行鼻再造 ,额部供区植皮 ,同期额部置入扩张器 ,Ⅱ期修复额部植皮区瘢痕。结果　共治疗了 1 0例患者 ,术后鼻外形良好 ,并对其进行随访 ,最长 3年 ,效果满意。结论　该方法证实具有远期鼻挛缩较少、额部瘢痕不明显等优点 ,临床效果良好     

额鼻皮瓣在鼻尖部缺损修复中的应用

目的介绍额鼻皮瓣在鼻尖部缺损修复中的应用经验。方法在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状、深度,设计以内眦动脉分支血管为蒂的轴型额鼻皮瓣覆盖创面。结果共施行手术21例,创面面积1.2cm×1.2cm~2.0cm×2.0cm。术后皮瓣全部成活,无明显并发症发生。其中18例获得随访1~36个月,鼻外形轮廓较好,修复组织与周围皮肤匹配良好。结论遵循鼻亚单位美学原则,应用额鼻皮瓣修复鼻尖部2.0cm×2.0cm以下创面,色泽、质地、轮廓等方面能达到较好的匹配和协调,可获得满意功能和美学效果。     

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。     

滑车上动脉的影像学研究及在鼻再造术中的应用

目的通过颈内、外动脉造影对滑车上动脉分支血管进行影像学研究,并设计改良额部皮瓣行鼻再造术。方法选用30例成人颈内、外动脉造影资料进行血管三维成像,对滑车上动脉分支(肌支和皮支)进行研究,探讨滑车上动脉分支走行、层次以及与眶上动脉的交通情况。根据影像学检测结果临床应用滑车上动脉分支设计额部皮瓣对11例鼻缺损患者行鼻再造术。其中男7例,女4例;年龄15～48岁,平均23岁。鼻缺损范围3.0 cm×2.5 cm～5.0 cm×3.5 cm。结果颈内动脉造影和三维成像显示,30例滑车上动脉恒定出现,直径(0.9±0.6)mm;其中浅层皮支恒定出现,直径(0.7±0.3)mm;深层肌支4例缺失,直径(0.5±0.5)mm,走行于额肌间,长(32.0±6.2)mm,分支间互有交通并与眶上动脉亦有吻合。临床应用皮瓣均成活,无软骨外露,外形良好。术后经4个月～3年随访,鼻尖、鼻翼及鼻小柱外形接近正常,鼻高度和坡度适中,再造鼻质地弹性良好,鼻孔无狭窄,通气功能正常。结论影像学检测结果佐证了滑车上动脉存在恒定皮支,以其分支为血管蒂设计的额部皮瓣提高了鼻再造疗效。     

成人单侧唇裂继发鼻畸形的整复

目的 为单侧唇裂术后常见的继发鼻畸形改善外形,解除其心理负担,方法 纠正鼻小柱和鼻中隔的偏斜,游离塌陷的鼻翼软骨并悬吊在对称位置,用Millard术式C瓣,鼻槛组织瓣或上唇瘢痕组织瓣延长患侧鼻小柱,必要时用假体或自体组织抬高鼻背,鼻尖和丰满鼻底,1999-2000年,共修复成人单侧唇裂继发鼻畸形50例。结果 所治疗50例术后随访1-12个月效果均较满意。结论 纠正鼻小柱,鼻中隔歪斜,延长患侧鼻小柱软组织极为重要。广泛游离患侧鼻翼软骨并复位到正常位置固定,才能获得一个对称的鼻尖,如视需要,作鼻背鼻尖部和鼻底的充填,则效果更佳。     

Transformation of the glabellar flap into an island flap

Summary Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. The narrowing of its vascular pedicle to the cutaneous arterial branch of the angular artery categorizing it as an axial flap pattern. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. The other two cases utilize a glabellar island flap based on a subcutaneous pedicle containing cutaneous arterial branch of the angular artery. This technique extends the mobility of this flap to allow one-stage reconstruction of adjacent defects.     

颞浅血管蒂额部岛状皮瓣修复鼻部分缺损

目的　研究颞浅血管蒂额部岛状皮瓣修复鼻部分缺损的方法。方法　自 1992年以来采用颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 17例 ,全层缺损以皮瓣远端折叠法或局部翻转皮瓣法制作衬里。皮瓣最小面积 1.5cm× 3cm ,最大面积 8cm× 10cm。结果　 17例中 ,移植皮瓣完全成活 12例 ,经随访 1～ 11年 ,鼻缺损修复后轮廓形态逼真 ,移植皮瓣颜色和周围肤色差别小 ,外形和功能良好。皮瓣供区痕迹不明显。移植皮瓣回流障碍 3例 ,术后局部遗留色素改变。移植皮瓣部分坏死 2例 ,皮瓣部分坏死后 3周 ,用对侧鼻唇沟带蒂皮瓣移植修复。结论　颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 ,是一种良好的选择。     

运用额部阶梯状皮瓣修复烧伤后鼻部畸形

目的探讨烧伤后鼻部畸形的修复方法。方法选择烧伤后鼻部有多个亚单位存在瘢痕挛缩或缺损的患者,其额部皮肤正常或留有浅表瘢痕。依照鼻部美学亚单位分布或整个鼻部单元,切除鼻部挛缩的瘢痕及部分正常皮肤,以使创面规则完整、移位的鼻翼及外翻的鼻黏膜复位。松解、切除鼻翼软骨与鼻侧软骨之间的瘢痕,以显现鼻翼沟。而鼻尖亚单位区的瘢痕则给予部分保留。若有衬里缺损,可翻转瘢痕瓣或周围正常皮肤制作衬里。以一侧滑车上动脉在眶上的皮支为蒂,形成额部正中或旁正中三叶状皮瓣。分离时,皮瓣大部在额肌表面掀起,近蒂部时达额肌下,呈阶梯状。皮瓣分离后,带蒂转移修复鼻部创面,供区移植皮片。3周后断蒂、修整。结果本组12例,术中均发现滑车上动脉在眶上1.5-2.0cm水平出现皮支走行于皮下。术后皮瓣均成活,随访3-12个月,鼻外形逼真,皮瓣色泽与周围皮肤相近,瘢痕不明显,通气良好。其中5例额部供区移植皮片后皮片色素沉着显著,3个月后行扩张皮瓣修复。结论以滑车上动脉眶上皮支为蒂的额部阶梯状皮瓣是修复烧伤后鼻畸形的一个良好选择。     

The use of mucosa-lined flap in nasal reconstruction

Summary A relatively new method of nasal reconstruction using a mucosa-lined flap is described. Surgery with mucosa-lined flaps is not yet commonly performed. Two cases are described in which this technique was employed. In the first case, a deeply penetrating squamous cell carcinoma of the right side of the nose, including the nasal mucosa, was excised. The nasal lining defect was closed with a free full thickness oral mucosa graft, and a median forehead flap was used to cover the nasal defect. In the second case, an ulcerated squamous cell carcinoma on the left side of the nose was excised and two-stage reconstruction performed. During the first stage, a free oral mucosa graft was transplanted into the nasal defect with its mucosal surface facing into the nasal cavity. A median forehead island flap was transferred to cover the inner layer of the graft. In the second stage, the obliterated nasal orifice was opened, and the inner lining was constructed by a segment of oral mucosa wrapped around a silicone nostril retainer. Application of an oral mucosa-lined flap would seem to be a superior method for nose reconstruction, since it does not distort the shape of the nose, and it reestablishes a patent nostril and preserves the delicate appearance of the nose.     

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。     

洞穿性全鼻缺损的修复再造

洞穿性鼻缺损的修复较为困难,本组病例采用局部皮瓣及癜痕瓣移植,并在皮瓣移植的方式上,改传统局部皮瓣旋转推进的方式为“合页样翻转”方式,避免了蒂部旋转,使切取皮瓣的面积充分利用,增加了复盖面积,使被封堵的缺损给鼻再造提供了完整基底,两种缺损同时得以修复。鼻再造选用额部扩张后皮瓣和前臂皮瓣为主,并依鼻骨缺损程度选用带骨皮瓣转移,取得较满意的效果。