自体肋软骨移植综合鼻成形术

Comprehensive rhinoplasty with transplantation of autologous costal cartilage

目的探讨应用自体肋软骨移植行综合鼻成形术的方法，观察手术效果。方法鼻部应用开放切口．取自体肋软骨移植行综合鼻成形术。截取6～7cm长第6或7肋软骨用于结构移植：（1）雕刻成柳叶形鼻背移植物用于隆鼻术；（2）雕刻成长条形鼻小柱支撑移植物用于鼻小柱支撑及鼻延伸术；（3）雕刻成盾牌形移植物用于鼻尖成形术。结果52例患者均获得满意的鼻背及鼻尖美学效果。鼻背轮廓线、鼻尖表现点、鼻尖上区转折清晰。无移植物外露、移位、软骨变形。亦未见气胸、感染、血肿等并发症发生，胸壁瘢痕不明显，效果满意。结论应用自体肋软骨移植行综合鼻成形术，可以满足对假体存在心理排斥的患者的求美需求，亦可为二次或多次鼻成形术后畸形的患者提供足够的自体修复材料，并大大的降低了再次手术感染的风险。其效果良好，并发症少，值得推广。

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage, and to observe the outcome and summarize the possible complications. Methods A 6- 7 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes. A lancet shaped piece was used for dorsal augmentation, several cartilage bars for collumellar elevation and nasal tip elongation. Comprehensive structural rhinoplasty was then done with open rhinoplasty incision. Results 52 patients were treated with this method and satisfying aes- thetic contouring of the nasal tip and dorsum was achieved. Among these patients, no such complica- tions as implant extrution or dislocation, cartilage distortion, pneumothorax, hemothorax, infection or hemotoma were observed. The scar on the donor site was not obvius. Conclusions Costal cartilage can meet the demands of patients who consider prosthesis as an unacceptable option. For secondary re- vision rhinoplasties, costal cartilage provides sufficient materials to ensure a promising outcome with lower risk of infection and other complications.