Reconstruction of the columella using the prefabricated reverse flow submental flap: A case report

BACKGROUND: The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. METHOD: In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. RESULT: The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. CONCLUSION: We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region.     

鼻尖区软组织缺损的即时修复

目的：探讨鼻尖区软组织缺损的即时修复的有效方法。方法：根据鼻尖及鼻小柱不同范围的软组织缺损，修复方法包括鼻唇沟皮瓣8例，轴型鼻背皮瓣3例，耳廓复合组织移植7例。结果：18例患者修复组织在色泽、质地上与受区接近，修复效果满意。结论：邻近部位皮瓣转移和耳廓复合组织移植是修复鼻尖端部不同范围的软组织缺损的较好方法。     

Microvascular reconstruction of the columella using a small radial forearm free flap: a case report

Columellar defects can result from various causes, a number of methods have been described for the reconstruction using local, regional, or free flaps. When local tissues are not available due to the presence of scars, free flaps become the treatment of choice. We present the case of a columellar defect resulting from a distal necrosis of a forehead flap in total nasal reconstruction. The columella was reconstructed using a small radial forearm free flap and a conchal cartilage graft. The flap and the graft survived completely with a satisfactory cosmetic result and good respiratory function during the follow-up time of 2 years. The result was achieved in a single-stage operation: the patient did not need any further procedures to improve the nasal appearance. We propose that the radial forearm free flap may be an easy and reliable alternative among the surgical options for columellar defects when local tissues are not available.     

超长蒂颞浅筋膜岛状皮瓣修复鼻部缺损

目的介绍超长蒂颞浅动脉筋膜岛状皮瓣修复鼻翼缺损的手术方式。方法29例外伤性鼻缺损，其中采用颞浅动脉额支筋膜岛状皮瓣修复12例，颞浅动脉顶支筋膜岛状耳后皮瓣修复14例。预制颞浅动脉顶支筋膜耳后皮瓣3例。结果27例皮瓣的颜色、质地和形态良好。疗效满意；2例出现皮瓣部分坏死，需再次修复手术。结论超长蒂颞浅动脉筋膜岛状皮瓣治疗鼻尖、鼻小柱及鼻翼缺损，供区损伤小，受区颜色形状好；并且预制的超长蒂颞浅动脉筋膜岛状耳后皮瓣血运可靠，可一次解决衬里问题，此皮瓣是修复鼻尖、鼻翼缺损的好方法。     

Nasal columella reconstruction with a composite free flap from the root of auricular helix

Defects of the nasal columella result in significant cosmetic and functional deformities. Over the years, a variety of methods for nasal columella reconstruction have been described in the literature, as have the technical difficulties of reconstructing this subtle structure. Here, a successful reconstruction of a 3.0 x 2.0 cm-wide nasal columella defect, with a chondrocutaneous microsurgical free flap from the root of the auricular helix, is presented.     

皮瓣游离移植修复再造唇缺损

1981年以来,我科应用吻合血管的前臂桡、尺侧(肌)皮瓣对17例唇缺损进行修复与再造,皮瓣全部成活。术后6个月～6年随访15例,外形及功能满意。讨论了唇缺损及合并鼻底、鼻翼、鼻小柱及牙槽嵴缺损的整复方法,认为游离前臂桡、尺侧(肌)皮瓣适于唇缺损的修复。     

Reconstruction of nasal tip and columella

Reconstruction of nasal tip and columella defects is demanding area with a range of reconstructive options, varying in complexity depending on requirements from simple skin grafting to multiple stage reconstruction with regional flaps. A framework is suggested to aid the reader in choice of reconstruction by classifying the defect based on size and the requirements of one to three layer (full thickness) reconstruction.     

细长皮管修复鼻小柱缺损

目的 总结通过留“桥”技术形成的细长皮管在鼻小柱再造中的应用。方法 １９６８年３月１９９８年８月,利用留“桥”技术形成细长皮管,分次转移,修复复杂鼻小柱缺损共１８例。采用上臂内侧纵行皮管１３例,颈部锁骨上横行皮管５例,设计皮管宽度２．０～２．５ｃｍ,长度１１～１５ｃｍ,皮管中段３～７ｃｍ于其一侧留“桥”。结果 １８例皮管均成活,无并发症,随访３～６０个月,再造鼻小柱外形、质地、色泽、抗损伤能力均良     

Reconstruction of the columella with nasolabial flaps

A one-stage operation is described for reconstruction of large defects of the columella nasi, the lower part of the nasal septum, and the vestibular floors. Nasolabial flaps are transported on a cranial, de-epithelialized pedicle, and passed deep to the nostrils into the vestibular cavity. The method is illustrated with four case reports.     

耳后游离皮片在修复鼻小柱与上唇粘连外翻畸形中的临床应用

目的：探讨耳后游离皮片在修复鼻小柱与上唇粘连外翻畸形中的临床应用。方法：首先设计皮片，局麻成功后，松解粘连的瘢痕组织，在耳后乳突区切取全厚皮片；将皮片修整后先固定鼻小柱缺损上端，在人中位置用褥式缝合使其形成人中及人中嵴，间断缝合受区皮片，最后固定打包加压；耳后供皮区两侧直接拉拢缝合。结果：采用该方法修复鼻小柱与上唇粘连外翻畸形8例，皮片全部成活，供受区切口均I期愈合。术后6～18个月对所有患者进行随访，鼻小柱与上唇粘连外翻畸形矫正良好，移植皮片色泽、质地接近周围正常组织，鼻小柱无明显偏移，供受区切口无明显瘢痕。结论：耳后游离皮片能较好修复鼻小柱与上唇粘连外翻畸形，具有术后瘢痕小，供区隐蔽等优点。     

单侧完全性唇裂术后继发鼻唇畸形的一次性修复

目的：介绍一种综合术式一次性整体矫正单侧完全性唇裂术后继发鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定，以缩窄以平齐鼻底；穹隆MT瓣成形术改善鼻孔形状；带侧翼鼻假体隆鼻突出鼻部立体感和加高鼻翼；上唇M瓣成形修整唇红缘重建唇弓；双侧口角为蒂的唇黏膜瓣或下唇瓦合式黏膜瓣修复上唇唇红过薄、过短或部分缺损。结果：单侧完全性唇裂术后继发鼻唇畸形21例，随访10例3个月至1年，外观和效果满意。结论：应用一针法鼻小柱鼻翼脚复位加MT成形术和双蒂唇黏膜瓣移植等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。     

鼻端部软组织缺损修复29例临床报告

目的探讨鼻端部软组织缺损修复的有效方法。方法根据鼻尖、鼻翼及鼻小柱不同范围的软组织缺损，修复方法包括邻近部位皮瓣转移修复19例(鼻唇沟皮瓣9例，额部皮瓣6例，轴型鼻背旋转皮瓣4例)，耳郭组织移植10例(复合组织块游离移植7例，反流轴型耳郭复合组织瓣3例)。结果29例惠者，随访2周至6个月，修复组织在色泽、质地上与受区接近，修复效果满意。结论耳郭复合组织移植和邻近部位皮瓣转移是修复鼻端部不同范围的软组织缺损的较好方法。     

Reconstruction of the nasal tip including the columella and soft triangle using a mastoid composite graft.

This paper describes the use of a composite graft from the mastoid area consisting of full-thickness skin peripherally and selectively localised fascia-fat tissue underneath the skin centrally for immediate reconstruction of moderate defects of the nasal tip including the columella and soft triangle. Mastoid composite grafting is a simple and safe procedure that avoids partial graft loss and provides adequate augmentation of soft tissue, easy reshaping of the new nostril rim, minimal post-operative shrinkage, and no donor-site morbidity. Then, it results in a satisfactory nasal appearance with adequate tip projection and symmetry. This procedure may represent a preferred method of nasal tip reconstruction.     

复杂性鞍鼻的综合整形术

目的：探讨复杂性鞍鼻的综合整复方法。方法：采用鼻翼软骨重塑改善鼻端形态，人中推进皮瓣加长鼻小柱，硅胶假体充填降鼻，以及鼻翼沟埋线缝合塑形加强鼻端部轮廓等综合技术，对10例复杂性鞍鼻进行整复。结论：经3个月至2年的随访，所有患者鼻背隆起，鼻尖抬高，鼻小柱延长，形态稳定，效果满意。结论：该综合整复术对复杂性鞍鼻可以得到较好的效果，手术方法简单易行，创伤小，易推广。     

Nasal reconstruction using split calvarial grafts.

The reconstruction of nasal deformities after trauma or surgical procedures presents an arduous task for the reconstructive surgeon. The anatomic alteration of supporting cartilage and nasal bones, as well as scar formation, compound the difficult nature of this type of reconstruction. In the past, multiple autogenous and alloplastic implants have been used in nasal reconstruction. Autogenous implants include auricular and septal cartilage as well as rib and iliac crest bone grafts. Alloplastic materials include acrylic, supramid mesh, Gortex, and silicone rubber. Autogenous grafts have been shown to provide excellent long-term reliable results in nasal reconstruction. In our study, autogenous split calvarial bone grafts were used in the nasal reconstruction of 17 patients. Among the corrective procedures were dorsal augmentation for saddle-nose deformities, insertion of columella struts for nasal tip ptosis, and insertion of nasal battens for nasal valve collapse. Patient followup has been from 1 to 5 years, with no significant resorption noted during that time. Complications were limited to one seroma at the donor site before wound drains were routinely used. No major complications, including hematoma formation, CSF leak, or infection, have been observed.     

Microvascular reconstruction of nasal defects

Microvascular reconstruction of nasal defects is a complex procedure and must consider 3 nasal components: skin, osteocartilaginous framework, and intranasal lining. These layers can be reconstructed with various flaps and grafts. The commonly used flaps are the first dorsal metacarpal flap, dorsalis pedis flap, auricular helical rim flap, and radial forearm and prelaminated flaps. These flaps can be composed of skin and cartilage or skin and bone. The decision is based on the patient's needs taking into consideration the extent of the defect and presence or absence of nasal septum and columella.     

Crab-pincers style facial artery flap.

To reconstruct defects as large as 5 cm in diameter in the region extending from the columella and anterior nasal floor to the upper lip, we use a crab-pincers style facial artery (CPFA) flap technique combining nasolabial flaps and cheek advancement flaps. In the CPFA flap, the bifurcation of the facial artery allows the angle between the nasolabial flap and the cheek advancement flap to be freely altered in the manner of crab pincers. By combining the four leaves of bilateral CPFA flaps at the centre, appropriate reconstruction of the three-dimensional structures surrounding the columella can be achieved. In addition, this method requires only one operation to complete extensive reconstruction. The method does not result in adverse scarring or scar contracture. After the procedure,appropriate moustache growth gives a natural impression and conceals philtral distortion. We consider the CPFA flap to be very useful for reconstructing large defects in the central facial region.     

Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip

PurposeTo demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction.MethodsThe surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method.ResultsFinite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up.ConclusionForce balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.     

Options for internal lining in nasal reconstruction

Nasal reconstruction has been refined to the point that its goals should include full restoration of form and function in addition to providing an aesthetically-pleasing result. Contemporary facial plastic surgeons have all the tools available in their armamentarium to repair the complex composite structure of nasal lining, structure, and skin cover. Nasal defects most often result from oncologic surgery or, less commonly, nasal trauma. While defects of nasal cover are more prominent, the impact of unrepaired nasal lining defects should not be underestimated. Meticulous repair of lining, structure and cover are all required for functional, stable and aesthetic nasal reconstruction.     

通过鼻再造术一次性修复鼻及鼻周缺损

目的：探索一次性修复鼻及鼻周缺损的治疗方法。方法：1995年～2008年,收治34例鼻及鼻周缺损的患者,男21例,女13例;年龄17～70岁。先行额部扩张器置入术。二期手术,利用缺损周围的局部翻转皮瓣形成鼻衬里,将缺损纳入鼻前庭;额部扩张皮瓣移位行鼻再造术。三期断蒂。病程6～26月。结果：34例患者,32例疗效满意。结论：将鼻周的缺损视作术后新鼻部解剖区的一部分,再造全鼻并修复缺损,重建面部美学解剖分区。该方法与传统方法相比,能够获得更为满意的效果。