山东大学耳鼻喉眼学报 ›› 2012, Vol. 26 ›› Issue (1): 31-34.

• 论文 • 上一篇    下一篇

额瓣联合鼻唇沟瓣一期修复鼻翼全层缺损

张维天1,关建1,程付伟1,张玉君1,朱华明1,郭金宝2,殷善开1   

  1. 1.上海交通大学附属第六人民医院耳鼻咽喉头颈外科, 上海 200233; 2.常州市第三人民医院, 江苏 常州 213000
  • 收稿日期:2011-10-14 出版日期:2012-02-16 发布日期:2012-02-16
  • 通讯作者: 殷善开,博士生导师,主任医师。 Email: yinshankai@china.com
  • 作者简介:张维天,博士,副主任医师,硕士生导师。

Singlestage reconstruction of large alar full thickness defect with the combination of island forehead flap and nasolabial flaps

ZHANG Wei-tian1, GUAN Jian1, CHENG Fu-wei1, ZHANG Yu-jun1, ZHU Hua-ming1, GUO Jin-bao2, YIN Shan-kai1   

  1. Department of Otorhinolaryngology, 1. the No.6 People′s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233, China; 2. Changzhou Third People′s Hospital, Changzhou 213000, Jiangsu, China
  • Received:2011-10-14 Online:2012-02-16 Published:2012-02-16

摘要:

目的   探讨联合应用岛状额瓣和鼻唇沟瓣一期修复鼻翼大面积全层缺损的方法和疗效。方法   回顾性分析4例应用该方法行全层缺损修复患者的临床及随访资料。患者均为男性,62~76岁,平均64岁。皮肤恶性肿瘤切除后缺损3例,外伤性缺损1例。缺损直径平均达3.3cm(2.5cm~4.5cm)。缺损累及两个外鼻亚单位1例,3个亚单位1例,4个亚单位2例。手术首先采用梨状孔边缘,鼻唇沟处皮下组织为蒂的梯形皮瓣向鼻腔内翻入修复衬里;再以该瓣外侧的三角瓣向内滑行修复梯形瓣遗留的缺损;接下来以滑车上动脉及伴行的内眦动脉丛为蒂的岛状额瓣经眉间皮下隧道覆盖鼻部皮肤缺损。结果    全部缺损一期修复成功,组织瓣全部成活,无坏死。1例患者术后半年随访时鼻孔略狭窄,有轻度鼻塞。随访6个月至3年,肿瘤无复发。结论   以皮下组织为蒂的岛状额瓣联合鼻唇沟瓣是一期修复鼻翼大面积全层缺损安全可靠的方法。

关键词: 外鼻;皮肤癌;重建外科技术;岛状瓣;鼻翼全层缺损

Abstract:

Objective   To discuss the methods and effects of large alar full-thickness defects reconstruction with combined application of island forehead flap and nasolabial flaps. Methods   We retrospectively reviewed the clinical and followup data in 4 patients who underwent singlestage reconstruction of large alar full-thickness defects with combined application of island forehead flaps and 2 nasolabial flaps from January 2008 to January 2011. All patients were male and the patients′ age ranged from 62 to 76 years, the mean age was 64 years, of which 3 cases of defects resulted from resection of skin malignant tumor (basal cell carcinoma in 2 cases, and acanthoma canceration in 1 case) and traumatic defect in 1 case.  The average diameter of defects was 3.3 cm (2.5-4.5cm).  Defects involved two subunits (tip + alar) in one case, three subunits (alar + tip+ nasal lateral side) in one case and four subunits (tip + alar + lateral side + dorsal) in 2cases. All patients had been excluded the risk factors of peripheral vascular disease. The first step, a trapezoidal flap of the medial nasolabial sulcus based on piriform aperture was harvested and turned into the nasal cavity to reconstruct the lining. Then the triangle flap of the lateral nasolabial sulcus was raised on a subcutaneous pedicle and was medially moved and sutured around the alar region. The third step, an island forehead flap, based on the subcutaneous pedicle containing the supratrochlear artery and the parallel terminal angular artery, was harvested and inferiorly transferred through the glabella subcutaneous tunnel to cover the nasal skin defect. Results   All defects were successfully repaired. All tissue flaps survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain after the postoperatively 6th month. There was no tumor recurrence during 6 months to 3 year follow-up.   Conclusions   In select cases, the paramedian island forehead flap in combination with two nasolabial flaps can be safely used and is an effectively method to repair the large alar full thickness defect.

Key words: External nose; Skin cancer; Reconstructive surgical procedures; Island flaps; Alar full thickness defect

中图分类号: 

  • R765.9
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