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。

Reconstruction of burned nasal deformities using forehead ladder skin flap

Objective To explore a repair method for burned nasal deformities. Method Patients with the sear or defects in several nasal subunits were chosen in this study. The forehead skin was normal or there was superficial sear in these patients. Based on the aesthetic subunits or the whole unit of the nose, the displaced alar and the everted nostril were repositioned following the excision of the sear and parts of the normal skin. After the scarred tissue was removed between nasal alar cartilage and lamina dorsi nasi, a proper alar groove was created. The seared tissue in the tip was partially remained. In a lining defect, scarred flap or adjacent normal tissue could be sutured to fill the deficiency. The trilobite flap of the median or paramedian forehead, which was pedicled on the cutaneous branches of the supratrochlear artery, was formed. The most part of the flap was elevated at the superficial plane of the frontal muscle. Near the pediele, the dissecting plane was under the frontal muscle, and the flap liked ladder. Then the harvested flap was transferred to the defect with the skin grafting on the donor site. The pedicle was divided and trimmed three weeks later. Results The forehead flaps were all survived in 12 patients. The color was well matched, and the sear was not obviouns. The ventilation was normal, and the contour of the newly reconstructed nose was satisfying. Only 5 patients were healed by the expander for the pigmentation of the skin-grafting after 3 months. Conclusions The reconstruction of burned nose with forehead skin flaps pedicled on cutaneous-branch of the supratrochlear artery is a good choice.