游离双层耳廓复合组织瓣在修复鼻翼全层洞穿性缺损中的应用  

Application of free double-layered auricular composite flaps in full thickness alar defects

作　　者：崔玮 刘全[1] 游晓波[1] 蒋治远 蔡震[1] 杜丽平[1] 陈再洪 盛阳 Cui Wei;Liu Quan;You Xiaobo;Jiang Zhiyuan;Cai Zhen;Du Liping;Chen Zaihong;Sheng Yang(Department of Plastic Surgery,Sichuan Provincial People’s Hospital&Sichuan Academy of Medical Sciences,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院整形外科,成都610072

出　　处：《中华整形外科杂志》2022年第11期1258-1264,共7页Chinese Journal of Plastic Surgery

基　　金：四川省科技计划项目(2018JZ0049)。

摘　　要：目的探讨游离双层耳廓复合组织瓣(含耳甲软骨及耳甲前皮肤)在修复鼻翼全层洞穿性缺损中的应用效果。方法回顾性分析2016年6月到2019年12月, 四川省人民医院整形外科收治的单侧鼻翼全层缺损患者的临床资料。均切取一侧耳甲游离的双层耳廓复合组织瓣, 作为鼻腔衬里, 外覆带蒂皮瓣修复全层鼻翼缺损。观察术后游离双层耳廓复合组织瓣存活情况, 带蒂皮瓣存活情况及后期重建鼻翼形态。结果共纳入12例单侧鼻翼全层缺损患者, 女4例, 男8例, 年龄6~53岁, 平均约35.3岁。衬里缺损面积0.7 cm×1.0 cm~2.0 cm×2.6 cm, 切取双层耳廓复合组织瓣面积为0.8 cm×1.0 cm~2.1 cm×2.7 cm。12例患者均一期愈合, 双层耳廓复合组织瓣及带蒂皮瓣均未出现坏死、感染等并发症。整个治疗周期完成后再造鼻翼形态和功能与正常鼻翼相近。末次手术后随访3~32个月, 平均约15个月, 所有皮瓣存活良好, 色泽与质地接近周围正常组织, 鼻翼形态良好, 未见相关远期并发症。结论游离双层耳廓复合组织瓣突破了全层耳廓复合组织瓣游离移植的面积限制, 其与带蒂皮瓣联合移植修复鼻翼洞穿性缺损, 可获得形态逼真的鼻翼。Objective To discuss the application of free double-layered auriclar composite tissue flap(auriclar cartilage and the skin)in repairing the full-thickness nasal alar defects.Methods The clinical data of the patients with unilateral full-thickness nasal alar defects who were admitted to the Department of Plastic Surgery of Sichuan Provincial People’s Hospital from June 2016 to December 2019 were analyzed.The free double-layered auricular composite grafts were harvested from the unilateral nasal cavity as the nasal lining and covered with pedicled skin flap.The survival of free double-layered auricular composite grafts and pedicled skin flap as well as the appearance of the reconstructed nasal alar were observed.Results A total of 12 patients with unilateral full-thickness alar defect were included,including 4 females and 8 males,aged from 6 to 53 years old,with an average of 35.3 years old.The areas of the defects were 0.7 cm×1.0 cm-2.0 cm×2.6 cm,and the areas of double-layered auricular composite grafts(skin)were 0.8 cm×1.0 cm-2.1 cm×2.7 cm.All the 12 patients healed primarily.No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap.After the completion of the whole treatment,the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained.After the last operation,the patients were followed up for 3 months to 32 months,with an average of 15 months.Conclusions The free double-layered auricular composite grafts breaks the area limitation of free transplantation of full-layer auricle composite tissue flap.The combined grafting with pedicled flap shortens the treatment duration with skin flap alone,and it is easier to obtain vivid nasal alar.

关 键 词：鼻肿瘤 鼻成形术 外科皮瓣 游离组织瓣 修复外科手术 双层耳廓复合组织瓣 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]