显微移植耳廓复合组织瓣再造鼻翼

Nasal alar reconstruction with a vascularized free auricular composite flap

目的 耳廓组织的形态、色泽和组织构造接近鼻翼组织 ,常被用于修复鼻翼缺损畸形。由于存在再血管化的问题 ,通常耳廓复合组织瓣的面积被严格限制在 1 0cm× 1 5cm以内。本研究旨在探索全层大块鼻翼组织缺损的修复方法。方法 应用显微外科技术 ,游离移植由颞浅血管供血的耳廓复合组织瓣再造鼻翼。游离带有长 3～ 4cm颞浅血管蒂的耳轮脚和耳前皮肤组织 ,移植至缺损的鼻翼部位 ,再通过切取长约 10～ 12cm左右的旋股外侧血管桥接于组织瓣的血管蒂和同侧面动静脉血管之间吻合血管。结果 本组共有 12例患者 ,11例手术获得完全成功 ,1例可能是由于自身血管条件较差而失败。鼻翼缺损面积从 1 5cm× 2 5cm到 2 0cm× 3 8cm。修复后的鼻翼形态外形较好 ,供区继发畸形程度能被患者接受。结论 吻合颞浅血管的耳廓复合组织瓣游离移植技术 ,是再造鼻翼缺损较理想的方法。

Objective The plastic surgeons prefer to reconstruct nasal alar with free auricular compos ite flap because it well matches nasal tissue in contour, texture and color. Ho wever, the size of the free composite flap should be less than 1.0 cm×1.5 cm due to the limitation of revascularization. Our aim is to search for a surgical method which could be used to repair full-layer larger nasal alar defects. Methods A surgical technique was presented to repair nasal alar defect with a free a uricular composite flap, which was vascularized by branches of superficial tempo ral artery. Briefly, the contralateral auricular composite tissue pedicled by s uperficial temporal vessels (3 to 4 cm in length) was harvested from region of h elix crus and preauricular skin, which matched the arc of the nasal rim, and the n transplanted onto the recipient area. The superficial temporal vessel pedicle s were anastomosed to facial vessels via vessel grafts harvested from lateral ci rcumflex femoral vessels, which were about 10 to 12 cm in length. Results Twelve cases were treated, among them, 11 cases were successfully repaired with satisfactory results, one case failed, possibly due to the bad condition of the patient′s blood vessels. In our cases, the size of alar defect varied from 1. 5 cm×2.5 cm to 2.0 cm×3.8 cm. The minimal auricular donor site deformities and inconspicuous scar were acceptable and could easily be hidden by hair. Conclusions The technique of free auricular composite fla p, which is vascularized by superficial temporal vessels, is ideal for nasal ala r reconstruction.