鼻部亚单位缺损修复方法的临床应用及探讨

发布时间：2018-09-16 20:57

【摘要】：目的通过对鼻部亚单位(鼻翼、鼻尖、鼻小柱、鼻根、鼻背)缺损患者选择合适的手术方法进行修复,并对其进行回顾性分析,探讨鼻部各个亚单位缺损的最佳修复方法。方法2005年2月～2015年2月,昆明医科大学第二附属医院整形外科门诊及住院部诊治270例因鼻部病变及外伤后瘢痕所导致的鼻缺损患者。根据患者鼻缺损部位及缺损面积大小选择不同的手术方法进行修复,对修复方法进行回顾性分析,并对部分病例进行为期3个月至3年的随访,分析其修复效果及满意度。结果2005年2月-2015年2月,昆明医科大学第二附属医院整形外科门诊及住院部诊治270例鼻缺损患者。50例(19%)缺损大于鼻部1/2中(包括鼻尖鼻翼联合缺损、鼻尖鼻翼鼻背联合缺损),40例应用额部扩张皮瓣进行鼻缺损修复,6例应用前臂扩张皮瓣,2例应用额部皮瓣,2例应用面部联合皮瓣；其中2例额部扩张器置入术后血肿,4例额部扩张器外露,2例二期皮瓣血运障碍,3例皮瓣臃肿。128例(47%)鼻翼缺损中,85例应用耳廓复合组织瓣游离移植修复,33例应用鼻唇沟瓣修复,7例应用额部扩张皮瓣,3例应用皮片移植术；其中2例耳廓复合组织瓣出现部分组织瓣坏死,1例鼻唇沟瓣导致口角牵拉,。10例(4%)鼻尖缺损,6例采用额部扩张皮瓣,4例采用双叶瓣,其中1例扩张器外露,1例鼻尖臃肿。8例(3%)鼻小柱缺损中,2例应用鼻底皮下蒂皮瓣,2例应用双侧鼻唇沟皮瓣,4例应用V-Y推进皮瓣,其中1例鼻唇沟皮瓣出现继发性鼻孔畸形,1例鼻底皮下蒂皮瓣出术后皮瓣臃肿。74例(27%)鼻根、鼻背缺损中,42例应用面颊部皮瓣(推进皮瓣8例、鼻唇沟瓣14例、菱形瓣20例),24例应用额部菱形瓣,8例应用额部扩张皮瓣。其中1例面颊部皮瓣修复术后出现眼角牵拉,2例额部菱形瓣修复术后出现双侧眉头不对称,1例扩张器外露,3例皮瓣臃肿。所有患者未见明显瘢痕挛缩,除即刻额部皮瓣转修复鼻缺损患者额部疤痕较明显外,其余患者供受区疤痕均较小。患者对修复效果均较为满意,尤其扩张皮瓣术及局部邻位皮瓣术后并发症少,再次挛缩率低；耳廓复合组织瓣游离移植修复鼻翼缺损术后色泽、质地、厚度匹配,患者对总体外观均比较满意。结论鼻部亚单位皮肤缺损的手术方法很多,但各种术式均有相应的适应证和优、缺点。全鼻或大于亚单位50%(包括鼻尖鼻翼联合缺损、鼻尖鼻翼鼻背联合缺损)时可考虑使用额部扩张皮瓣行缺损修复。若额部皮肤损伤可考虑使用前臂扩张皮瓣进行修复；中小面积鼻翼缺损选择耳廓复合组织瓣游离移植修复.对于整个亚单位鼻翼缺损采用额部扩张皮瓣修复.鼻内衬里完好的鼻翼缺损选择鼻唇沟瓣；中小面积鼻根、鼻背、鼻侧壁缺损首选邻位皮瓣,大面积缺损选择额部扩张皮瓣；鼻小柱缺损选择双侧鼻底皮下蒂皮瓣；鼻尖缺损首选额部扩张皮瓣、皮肤松弛及老年患者选用双叶瓣。
[Abstract]:Objective To explore the best method of repairing the defect of nasal subunit (alar, tip, columella, root and back) by retrospective analysis of the patients with nasal subunit defect. 270 cases of nasal defects caused by nasal lesions and traumatic scars were treated in our hospital. Different surgical methods were selected according to the site and size of the nasal defects. The repair methods were retrospectively analyzed. Some cases were followed up for 3 months to 3 years, and the results and satisfaction were analyzed. From February 2005 to February 2015, 270 patients with nasal defect were treated in the outpatient and inpatient department of the Plastic Surgery Department of the Second Affiliated Hospital of Kunming Medical University. 50 patients (19%) had more nasal defect than 1/2 of them (including nasal tip-alar defect, nasal tip-alar-nasal-dorsal defect). 40 patients had nasal defect repaired with forehead expanded flap, 6 patients had forearm expanded flap, and 2 patients had nasal defect. Among 128 cases (47%) with nasal alar defect, 85 cases (33 cases) with auricular composite tissue flap, 33 cases (33 cases) with nasolabial groove flap, and 7 cases (7 cases) with frontal expanded skin flap. Among them, 2 auricle composite tissue flaps were necrotic, 1 nasolabial groove flaps caused cornual pull, 10 (4%) nasal tip defects, 6 forehead expanded flaps, 4 bilobed flaps, 1 dilator exposure and 1 nasal tip bloated. Among 8 (3%) cases of nasal columellar defects, 2 nasal base subcutaneous pedicle flaps were used. 2 cases were treated with bilateral nasolabial groove flap, 4 cases with V-Y push flap, 1 case with nasolabial groove flap secondary nostril deformity, 1 case with nasal floor subcutaneous pedicle flap after operation. 74 cases (27%) of nasal root and nasal dorsum defects, 42 cases with cheek flap (8 cases of push flap, 14 cases of nasolabial groove flap, 20 cases of rhomboid flap), 24 cases with forehead rhomboid flap, 8. Among them, 1 case had cornual distraction, 2 cases had bilateral eyebrow asymmetry, 1 case had dilator exposure and 3 cases had bloated skin flap. No obvious scar contracture was found in all patients, except that the frontal skin flap was transferred to repair nasal defect immediately. The scars in donor and recipient areas were all small. The patients were satisfied with the repairing effect, especially the expanded flap and local adjacent flap with fewer complications and low re-contracture rate. The color, texture and thickness of auricle composite tissue flap after free transplantation for repairing nasal alar defect were matched, and the patients were satisfied with the overall appearance. There are many surgical methods, but all kinds of surgical methods have corresponding indications, advantages and disadvantages. When the total nose or greater than 50% (including nasal tip and alar combined defects, nasal tip and alar combined defects) may consider the use of forehead expanded flap for defect repair. The nasal alar defect was repaired by free auricle composite tissue flap. The nasal alar defect with intact nasal lining was repaired by expanded forehead flap. The nasolabial groove flap was used for repairing the nasal alar defect; the adjacent flaps were preferred for small and medium area nasal root, nasal dorsum and nasal lateral wall defects, and the expanded forehead flap was used for large area defect. Bilateral nasal base subcutaneous pedicle flap; nasal tip defect preferred expanded forehead flap, skin relaxation and elderly patients choose bilobed flap.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R622

【相似文献】