逆行耳前耳廓复合组织瓣显微移植再造鼻亚结构

目的探索吻合逆行颞浅血管供血的耳前耳廓复合组织瓣移植修复鼻亚结构缺损的临床应用方法。方法2003年6月~2005年8月,应用显微外科技术,游离移植逆行颞浅血管供血的同侧耳前耳廓复合组织瓣,修复鼻尖、鼻软三角和鼻翼全层缺损12例,男4例,女8例;年龄14~35岁。鼻尖鼻软三角联合缺损3例,单侧鼻翼缺损9例。病程6个月~12年。术中切取组织瓣范围2.0 cm×1.5 cm~3.0 cm×2.5 cm,逆行血管蒂长4~6 cm。血管蒂直接与受区附近的鼻旁角动脉吻合。结果11例组织瓣血管与角动脉和静脉直接吻合,1例因未找到受区适宜血管,采用血管移植方法与供区颞浅血管近侧残端吻合。术后12例移植组织瓣全部成活。均获随访3~6个月,患者对术后鼻的外形满意,对供区耳廓及耳前的术后修复结果能接受。结论逆行颞浅血管供血的耳前耳廓复合组织瓣移植修复鼻亚结构缺损,可避免血管移植供区损伤,减少血管吻合口数量及副创伤,提高手术成功率,值得进一步临床推广。

RECONSTRUCTION OF NASAL SUBUNITS WITH REVERSED VASCULARIZED PREAURICULAR AND EAR COMPOSITE FLAP

OBJECTIVE: To explore the technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap. METHODS: From June 2003 to August 2005 the preauricular and ear composite flap, which was pedicled by the reversed superficial temporal vessel, was harvested and transplanted to repair the defects of the nasal tip, soft triangle, and ala by the microsurgical technique. The flap ranged in area from 3.5 cm x 2. 5 cm to 2. 0 cm x 1. 5 cm, with the pedicles 4 to 6 cm in length. The reversed superficial temporal vessel pedicles were directly anastomosed to the angular artery and vein adjacent to the nasal ala. RESULTS: Among the 12 patients who had been treated, 11 had their vessel pedicles successfully anastomosed to the angular vessels, while the remaining 1 patient had the stump of the superficial temporal vessel anastomosed after the flap harvest via the vessel graft because the angular vessels were not found in the recipient area. All the flaps survived with a satisfactory esthetic result after operation. CONCLUSION: The technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap, which is directly anastomosed to the angular vessel, can avoid the vessel grafting and therefore it can avoid an additional damage to the patient.