鼻再造术中衬里组织的修复方法  

Repair of nasal lining in nasal reconstruction

作　　者：李玉萍[1] 姜浩[1] 顾斌[1] 沈国雄[1] 李青峰[1] 

机构地区：[1]上海交通大学附属第九人民医院整复外科,200011

出　　处：《中华整形外科杂志》2007年第6期483-486,共4页Chinese Journal of Plastic Surgery

基　　金：国家教育部科技发展基金（NCET-04-0436）;上海市卫生局科技发展基金（02BR013）

摘　　要：目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。Objective To present a variety of techniques for providing nasal lining and discuss the application of these methods to specific nasal defects. Methods Regard of the nasal defect＇s location, size, or depth of involvement, the approaches were used with turnover nasal skin or scar flaps （ n = 17 ）, the buccal mucosal flap （ n = 1 ）, the nasolabial flaps （ n = 5 ）, prefabricated flaps （ n = 1 ） for lining. A formal nasal reconstruction was then carried out with use of rib cartilage grafts for support and a forehead flap for cover. Results Necrosis of forehead flaps and lining tissues did not occur. 24 Cases have been followed for a 6 - 34 months period. Except some turnover scar flaps obstructed the airway and needed aggressive secondary surgical thinning, the other lining flaps remained stable from adequate restoration of form and function. Conclusions It is important to evaluate the exact sizes, volumes and layers missing of the nasal defects before rebuilding the lining defect. Choosing the adequate operation can provide good aesthetic and functional results. The prefabricated flap is good to be used to reconstruct nasal lining in complicated cases.

关 键 词：鼻再造 预构皮瓣 鼻唇沟皮瓣 

分 类 号：R686[医药卫生—骨科学]