鼻唇沟皮瓣联合耳廓复合组织瓣修复鼻翼缺损

Reconstruction of full-thickness nasal alar defect with combined nasolabial flap and free auricular composite flap

目的 探讨鼻唇沟皮瓣联合带有单侧皮肤的游离耳廓软骨组织瓣修复鼻翼全层缺损的方法及效果.方法 2010年3月至2013年3月,对9例鼻翼全层缺损患者,采用鼻唇沟皮瓣联合带有单侧皮肤的游离耳廓软骨组织瓣修复,且保留2～3 mm耳轮边缘处反折的皮肤,以复合组织瓣修复鼻翼衬里及软骨支架,同侧鼻唇沟皮瓣修复外被皮肤.结果 所有患者术后均获随访6 ～18个月,平均12个月,9例软骨组织复合瓣全部成活,其中1例鼻唇沟皮瓣远端切口缘出现表皮坏死,经给予清痂、换药治疗后痊愈.6例术后鼻翼缘接近正常,鼻孔和鼻外形对称;3例鼻翼缘弧度和耳廓复合组织瓣饱满度不够,鼻孔轻度不对称.结论 鼻唇沟皮瓣可以增大游离耳廓软骨组织瓣成活面积,保留的耳轮反折皮肤可使重建的鼻翼缘弧度光滑自然,应用鼻唇沟皮瓣联合带有单侧皮肤的游离耳廓软骨组织瓣可以修复大面积鼻翼全层缺损.

Objective To investigate the technique and its effect of combined nasolabial flap and free auricular composite flap for full-thickness nasal alar defect. Methods From March 2010 to March 2013, 9 patients with full-thickness nasal alar defects were treated with combined nasolabial flaps and free auricular composite flaps. Composite auricular flap was used as inner lining and cartilage framework. The nasolabial flap at the same side was used as outer lining. Results All the patients were followed up for 6- 18 months （average, 12 months）. All the 9 composite auricular flaps survived completely. Epidermal necrosis happened at the distal end of 1 nasolabial flap. Alar rim was almost normal and symmetric nose was achieved in 6 cases. The arc and the thickness of the alar rim was not enough in 3 cases, resulting in asymmetric appearance. Conclusions The survival area of auricular composite flap can be enlarged with nasolabial flap. The auricular helix edge can be reserved to reconstruct nasal alar rim with smooth and natural arc. Large full-thickness nasal alar defedts can be reconstructed with combined nasolabial flaps and free auricular composite flaps.