全鼻再造手术方法的探讨

Evaluation of methods for total nasal reconstruction

目的 介绍 4种全鼻再造的手术方法及适应证。方法 1975～ 2 0 0 3年我们应用①上臂皮管全鼻再造术、②传统前额正中皮瓣全鼻再造术 +额部植皮术、③额部正中皮瓣全鼻再造术 +双侧额颞皮瓣滑行修复额部供区、④额部皮瓣扩张术后行额正中皮瓣全鼻再造术 ,对 2 2例行上述全鼻再造术者进行了回顾性分析 ,并讨论了上述手术方法的优缺点及其适应证。结果 本组病例均获成功 ,外形及通气功能效果良好。应用第 2种方法虽然再造鼻外形满意 ,但在额部留下明显而深暗的凹陷痕迹 ,影响美观 ;而应用第 1种方法额部不留任何痕迹 ,但鼻再造所需时间较长 (约 2个月 ) ,且需将上臂与头部间固定 3周 ,是其不足之处。结论 如采用前额正中皮瓣法行全鼻再造时 ,建议对鼻型较小者应用第 3种方法 ;而对鼻型较大者以用第 4种方法为好 ;而对于不接受在额部造成新的创伤或额部组织不足者 ,应选用第

Objective To evaluate the advantages, disadvantages and their indications of total nasal reconstruction with different techniques. Methods\ A series of total nasal reconstruction were treated with four methods from 1975 to 2003. These methods were tubed flap of arm,midline forehead flap with skin graft, midline forehead flap with bilateral frontotemporal flaps for repairing the donor site, and expanded forehead flap. Results\ All of the patients were treated successfully. The shape and function of the reconstructed noses were satisfactory. However, the traditional forehead flap with skin graft may leave a unsightly big and black scar on the forehead. The technique of the tubed flap of arm could provide enough tissue without remaining forehead scar and be easily shaped, but it required long period, multiple procedures and body fixation for three weeks. Conclusions\ Midline forehead flap with bilateral frontotemporal flaps for repairing the donor site may be good for small nose reconstruction while expanded forehead flap could reconstruct a big nose. Tubed flap of arm may be used to the patients who do not wish to leave any scar on the forehead.Forehead flap with skin graft to repair the donor site should generally be avoided for nose reconstruction.