额部阶梯状皮瓣与肌、皮双瓣鼻再造术  

Nasal reconstruction with forehead skin flap and muscle flap

作　　者：李青峰[1] 雷华[1] 顾斌[1] 刘凯[1] 沈国雄[1] 郑丹宁[1] 郑胜武[1] 

机构地区：[1]上海第二医科大学附属第九人民医院整形外科,200011

出　　处：《中华整形外科杂志》2004年第5期351-353,共3页Chinese Journal of Plastic Surgery

基　　金：上海市卫生科技发展基金资助项目 ( 97 0 13 )

摘　　要：目的　改良目前常用的额肌皮瓣鼻再造术 ,克服其形态臃肿 ,再造鼻高度受限等不足 ,进一步提高手术效果。方法　根据新观察到的滑车上动脉于眉上存在一相同走向的皮支的解剖特点 ,设计额部阶梯状皮瓣与肌、皮双瓣 ,前者用于克服肌皮瓣臃肿 ,再造鼻形态欠佳的缺点 ,一次成形鼻各组成结构。后者组成结构肌瓣用于构建鼻中隔结构 ,适用于复杂病例 ,并可增加再造鼻高度。结果　 9例患者术中均可见滑车上动脉于眶缘上 1 2～ 1 7cm开始有皮支行于皮下 ,且与对侧有交通支。术后皮瓣全部成活 ,其中 1例鼻小柱右侧支架外露 ,经二次手术修复痊愈。鼻各组成结构塑形良好。结论　额部阶梯状肌皮瓣和肌、皮双瓣适用于修复不同程度的鼻缺损 ,再造鼻形态较好 ,可为鼻再造的首选方法。Objective To improve the paramedian forehead flap for nasal reconstruction. Methods Based on the findings of the Cutaneous branch of supratrochlear artery,the forehead musculo-cutaneous flap was divided into the musculo-flap and the skin-flap in 3 patients.The musculo-flap were used to reconstruct the septi-bone structure,and envelop silicon nasal-frame,while the skin-flap were used to reconstruct the nose. In 6 patients,the forehead flap was used as a skin-flap just with the muscle pedicle to reconstruct a nose with good appearance of nasal subunits,without the secondary operation. Results In all of 9 cases,the cutaneous-branch of supratrochlear artery was found 1.7～2.0 cm above the orbital-rim. Eight patients got good results,only 1 patient had to do the secondary operation to coverage the exposed nasal frame. Conclusions The cutaneous-branch of supratrochlear artery could be an anatomical finding to form the forehead skin-flap and it is a good choice to be used to reconstruct a nose,even in complicated cases. ;

关 键 词：额部 肌皮瓣 鼻再造术 阶梯 动脉 修复 皮下 形态 组成结构 构建 

分 类 号：R622[医药卫生—整形外科]