从美学角度对额部扩张皮瓣行外鼻重建术的改进

Improvement in nasal reconstruction with an expanded forehead flap from an aesthetical point of view

目的探讨从美学角度重建外鼻的手术方法及优点。方法对12例鼻下端缺损行额部扩张皮瓣修复，在额部帽状腱膜下方斜向置入皮肤软组织扩张器，采用常规扩张法注液，以鼻背皮肤及鼻端残余瘢痕和黏膜作为衬里，测量患者鼻翼或内眦间距，在扩张的皮肤上以此为基准按美学标准设计三叶肌皮瓣，向下翻转再造外鼻，按美容亚单位分区修剪皮瓣至不同层面并塑形。结果12例鼻缺损患者术后无一例皮瓣坏死，随访6个月至1年，鼻形态自然、美观。结论从美学角度按个体化标准化设计的三叶肌皮瓣再造全鼻安全、理想。术中皮瓣的塑形、血运良好的鼻衬里、鼻支架的Ⅰ期置入也是鼻形态良好的关键。

Objective To investigate the operative methods and merits of nasal reconstruction in terms of the aesthetics. Methods The noses of 12 patients were reconstructed with an expanded triangle-shaped forehead flap with unilateral supratrochlear artery, a skin expander was placed obliquely under galea aponeurotica of forehead. Liquid was injected with conventional expansion method. Using the skin and the scars on nasal dorsum and tip as lining, based on intercanthal distance and aesthetic standard, a triangle-shaped forehead myocutane-ous flap was designed over the expanded forehead skin tissue and used for a nasal reconstruction. The triangle- shaped flap was trimmed to different layer and reshaped based on aesthetic subunit. Results In twelve post-operative patients with nasal defect, no flap necrosis was found and the appearance of reconstructed noses were almost normal and satisfactory after follow-up for 6 months to 2 years. Conclusion The modified forehead myocutaneous flap according to aesthetic standard is safe and ideal for major nasal reconstruction. Meticulous moulding of triangle-shaped flap, nose interior with good blood supply, and primary insertion of nose stretcher are the key to a satisfactory appearance.