沿鼻翼轮廓线肋软骨移植联合V-Y推进瓣矫正鼻翼缘退缩畸形

Correction of retracted nostril alar rim with alar contour cartilage graft combined with V-Y advance flap

目的探讨应用沿鼻翼轮廓线肋软骨移植联合V-Y推进瓣矫正鼻翼缘退缩畸形的手术方法及临床效果。方法从右侧第六肋切取肋软骨作为移植物,取跨鼻小柱"Λ"形切口经穹窿部至鼻翼软骨下缘,基底沿鼻翼缘设计一含皮肤、前庭皮肤、黏膜的"V"形皮肤黏膜瓣,于鼻翼缘两侧皮肤之间沿皮下向远端分离形成一"囊袋"形腔隙,向外展开囊袋形成新的鼻翼缘,将肋软骨片移植物插入囊袋内,通过V-Y推进,"Y"形缝合切口及皮肤切口使鼻翼缘下移,鼻翼缘贯穿缝合固定移植物。鼻孔内以凡士林纱布包裹硅胶管支撑,鼻背以热塑板塑形。结果采用此方法矫正鼻翼缘退缩畸形27例,有效的使鼻翼缘复位,术后随访患者均满意。结论沿鼻翼轮廓线肋软骨移植联合V-Y推进瓣是矫正鼻翼缘退缩畸形的有效方法,值得临床推广。

Objective To explore the surgical method and clinical efficacy of alar contour cartilage graft combined with V-Y advance flap in correction of retracted nostril alar rim. Methods The right 6th costal cartilage was harvested as cartilage graft. The transnasal column"Λ"-shape incision was taken from the fornix to the lower edge of the alar cartilage. A"V"-shape skin mucosal flap was designed, including the skin, vestibular skin, and mucous membrane along the nostril alar rim. A"pouch"cavity was formed, separating from the subcutaneous to the distal end between the skin on the two sides of the nasal alar. The pouch was expanded outwardly to form a newalar edge and the costal cartilage graft was inserted into the pouch. Through V-Y propulsion, the "Y"-shape sutured incision and skin incision made the alar edge move downward. The transfixing suture was performed in the nostril alar rim to fix the graft. The silicone tube was wrapped with Vaseline gauze to support the nostril, and the nose was shaped by a thermoplastic plate. Results A total of 27 patients with retracted nostril alar rim achieved correction by this method. The nostril alar rim was restored effectively, and patients were satisfied with the results.Conclusion The alar contour cartilage graft combined with V-Y advance flap was an effective method to correct retracted nostril rim.