鼻尖鼻背缺损延期局部皮瓣修复的疗效观察

目的 探讨鼻部急诊外伤病例中鼻尖鼻背部缺损延期局部皮瓣修复的临床疗效及应用推广的可能性。 方法 回顾性分析上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科于2011年1月至2014年1月急诊收治的鼻尖鼻背部皮肤及皮下、肌肉组织、软骨层部分缺如的8例外伤患者的临床资料。其中男7例,女1例。纯鼻尖缺损3例、单纯鼻背缺损2例、鼻尖合并鼻背缺损3例。所有病例均先在急诊行清创止血初步处理,并入院接受局部换药及全身应用抗生素治疗1~3 d,然后在全麻下行缺损区局部皮瓣转移修复以及重建鼻部外形的手术治疗。 结果 所有患者随访6个月~2年。8例患者术后皮瓣全部存活。所有患者无局部感染或者坏死的发生。对于近期和远期的鼻部外形,或者鼻腔的通畅程度上,患者及手术医生主观评定均较满意。患者的生活及社交能力均未受到明显损失。 结论 对于外伤所致鼻尖鼻背缺损的患者,选择性地给予清创换药和抗炎数日处理后再延期全麻下行局部皮瓣修复是可行且有效的。同时经过局部一定时期的换药后患者接受手术的耐受力较好。

Curative effect of delayed local flap repair on defects of the nasal tip and dorsum in nasal emergency trauma

Objective To investigate the clinical efficacy of delaying local flap repair of apical and dorsal nasal defects in nasal emergency trauma cases. Methods A retrospective analysis of eight trauma patients with apical and dorsal nasal cutaneous, subcutaneous, musculature, and cartilage defects was performed at the Department of Otorhinolaryngology Head and Neck Surgery, Ninth Peoples Hospital affiliated with Shanghai Jiaotong University School of Medicine between January 2011 and January 2014. There were seven male and one female patients; three had pure tip defects, two had simple nasal defects, and three had nasal tip defects combined with dorsum defects. All patients were initially treated with debridement and hemostasis at the emergency department before being admitted to the hospital for local dressing and systemic antibiotic therapy for 1 to 3 days. Afterwards, reconstruction of the nose with local and distant flaps was performed under general anesthesia. Results All patients were followed up for a period of 6 months to 2 years. All eight patients survived the flap without local infections or necrosis. Subjective assessments of the nasal appearance and patency performed at the short and long term follow-up visits were satisfactory to both patients and the surgeon. There was no significant impact on the quality of life of patients. Conclusion It is feasible and effective to delay the local flap repair in patients with sharp dorsal nasal defects for several days, while providing them with debridement and anti-inflammatory treatment at the emergency department. After several days of treatment and local dressing changes, the patients could tolerate surgery better.