鼻整形术后感染导致局部组织缺损的早期皮瓣修复

目的：探讨鼻整形术后感染导致鼻组织缺损行早期皮瓣修复的可能性、手术时机及手术方法。方法：11例鼻整形术后感染患者，依照鼻整形手术亚单位原则，共行15例次早期皮瓣修复。缺损类型包括鼻背、鼻尖、鼻尖瘘孔；缺损面积1．5cm×1．2cm～2．0cm×2．5cm，瘘孔直径0．6～0．9cm。皮瓣类型包括鼻背瓣、菱形瓣和鼻小柱鼻尖瓣。观察修复后早期出现的鼻部结构改变及手术效果维持情况。结果：15例次皮瓣均Ⅰ期愈合。随访4～27个月，鼻外形及视觉效果良好，修复组织与周围皮肤在色泽、质地、光化性损害程度等方面匹配良好。2例鼻尖出现结构不对称，行皮下注射填充后解剖结构恢复。结论：依照鼻整形手术亚单位原则，早期合理选择个体化皮瓣修复方式，可获得较好的鼻功能性及美学效果，恢复患者社会生活交流能力。

Early local flap reconstruction in nasal defect due to severe infection after rhinoplasty

Objective： To explore the feasibility, option of surgical method and surgery opportunity of local flap reconstruction in nasal defects due to severe infection after rhinoplasty. Method.. The clinical datum of eleven patients, who had 15 cases of local flap reconstruction due to severe infection after rhinoplasty, were analyzed retrospectively. The lesions included defects of nasal dorsum, nasal tip and anterio-nare-vestibular fistula. Areas of defects ranged from 1.5 cm× 1.2 cm to 2.0 cm× 2.5 cm and fistula diameters fell between 0.6 cm and 0.9 cm. Based on the principal of nasal aesthetic sub-unit, nasal defects were restored with local flaps, such as nasal dorsum flaps, rhomboid flaps and nasal columella-tip flaps. The early changes and the maintenances of nasal contour after reconstruction were observed. Result： All 15 reconstructions were carried out 2 weeks after control of infection, and stage I recovery was achieved in all the cases. In the follow-up periods from 4 to 27 months, all the flaps survived, only 2 cases had distortion of nasal tips, however, they were recovered with subcutaneous injection restoration; the other cases received satisfactory nasal contour where the flaps matched well with the neighbor skin in color, texture and extent of actinic dermatitis. Conclusion： Based on the principal of nasal aesthetic sub-unit, the individualized early local flap reconstruction would have good effect on nasal function and aesthetics, which will restore self-confidence of the patients as soon as possible.