四种局部穿支皮瓣在鼻翼缺损修复中的应用  

Application of four kinds of local perforator flaps in reconstruction of nasal wing defects

作　　者：刘誉 李小静[1] 宁金龙[1] 万丽颖 王文静[3] Liu Yu;Li Xiaojing;Ning Jinlong;Wan Liying;Wang Wenjing(Department of Plastic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;The First Clinical Medical College of Anhui Medical University,Hefei 230032,China;Department of Nursing,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院整形外科,合肥230032 [2]安徽医科大学第一临床医学院,合肥230032 [3]安徽医科大学第一附属医院护理部,合肥230032

出　　处：《中华整形外科杂志》2020年第2期157-164,共8页Chinese Journal of Plastic Surgery

摘　　要：目的探讨4种局部穿支皮瓣修复鼻翼缺损的应用方法及临床效果。方法回顾性分析2015年6月至2018年6月安徽医科大学第一附属医院收治的41例各种原因导致的鼻翼缺损患者的临床资料,其中男22例,女19例,年龄15~93岁,平均45岁。鼻翼处缺损处面积为0.4 cm×0.4 cm^2.5 cm×2.5 cm,分别采用鼻唇沟角形穿支皮瓣(20例)、鼻翼基底穿支鼻唇沟岛状皮瓣(6例)、唇上-鼻唇沟角形穿支岛状皮瓣(5例)或鼻外侧动脉角形穿支皮瓣(10例)进行修复。术后对患者进行随访,观察鼻翼形态和鼻部功能,以及癌肿病例复发情况。结果41例皮瓣全部成活,皮瓣切取范围为0.5 cm×1.5 cm^4.0 cm×4.0 cm,鼻翼缺损完全修复,伤口均为一期愈合。术后所有病例均进行了4个月至1年的随访,术后鼻翼形态较好,鼻部功能未受影响,癌肿病例未见复发。结论鼻翼缺损面积较大时选用鼻唇沟角形穿支皮瓣,面部皮肤张力较大时采用鼻翼基底穿支鼻唇沟岛状皮瓣经皮下隧道修复,缺损邻近鼻唇沟处时宜用唇上-鼻唇沟角形穿支皮瓣,缺损面积较小时采用鼻外侧动脉角形穿支皮瓣修复。根据情况合理地选择皮瓣,均可获得较好的美学效果。Objective This paper introduces four surgical methods and effects of one-stage repair for defect in nasal wing because of tumor resection and other reasons.Methods Totally 41 cases of nasal wing defects caused by various reasons admitted to the First Affiliated Hospital of Anhui Medical University from June 2015 to June 2018 were analyzed retrospectively,including 22 male patients and 19 female patients,age ranged from 15 to 93 years,with an average of 45 years.All patients were treated and repaired with the nasolabial horn-shaped perforated pedicle flaps(20 cases),the lateral nasal artery horn-shaped perforated pedicle flaps(10 cases),the nasolabial sulcus island flaps based on nasal basal perforator vessel(6 cases)and the supralabial-nasolabial horn-shaped perforated pedicle flaps(5 cases).Results All the flaps that were used in 41 patients were transplanted successfully,size ranged from 0.5 cm×1.5 cm-4.0 cm×4.0 cm.The defects on the nasal wing were completely repaired,and the wounds healed in one stage.All patients underwent postoperative follow-up for a period of 4 months to 1 year.Postoperative results indicate that the patients’alae shapes of the nose were good,the functions were not significantly affected,and no recurrences were found in the cancer cases.Conclusions The nasolabial horn-shaped perforated pedicle flap can be used for lager defects of the the nasal wing,and the lateral nasal artery horn-shaped perforated pedicle flap can be used for the minor defects.In addition,the nasolabial sulcus island flap based on nasal basal perforator vessel can be used when the facial skin tension is greater.Finally,the supralabial-nasolabial horn-shaped perforated pedicle flap is suitable when the defect is near the nasolabial sulcus.All patients can obtain better aesthetic results when the flap is selected according to the actual situation and reasonably.

关 键 词：鼻畸形 获得性 鼻肿瘤 外科皮瓣 穿支皮瓣 角形穿支皮瓣 鼻翼缺损 

分 类 号：R76[医药卫生—耳鼻咽喉科]