不对称蝶形切口联合鼻前庭V-Y推进皮瓣修复单侧唇裂继发鼻畸形

Application of asymmetric butterfly incision combined with vestibular V-Y advance flap in repairing unilateral secondary cleft lip nasal deformity

目的 探索不对称蝶形切口联合鼻前庭V-Y推进皮瓣修复单侧唇裂继发鼻畸形的方法及疗效.方法 采用双侧鼻翼及鼻小柱的不对称蝶形切口联合鼻前庭内的V-Y推进皮瓣,对62例单侧唇裂继发鼻畸形的患者进行修复,术后随访观察鼻部外形的主观和客观指标.结果 术后切口均一期愈合,随访3 ～12个月,终末随访时进行效果评价.58例患者双侧鼻翼、鼻孔对称,各角度观察外形满意,双侧鼻孔径差异绝对值之和＜3 mm;2例患者双侧鼻翼、鼻孔对称,各角度观察外形较满意,双侧鼻孔径差异绝对值之和为分别为3.5、4.2 mm;2例患者裂侧鼻翼再次塌陷,外形欠满意,双侧鼻孔径差异绝对值之和＞5 mm.结论 采用双侧鼻翼及鼻小柱的不对称蝶形切口联合鼻前庭内的V-Y推进皮瓣,可以较好地对唇裂侧鼻翼皮肤、软骨、黏膜等组织进行解剖复位,临床效果良好.

Objective To explore a new surgical method and its effect in repairing secondary nasal deformity of unilateral cleft lip.Methods Sixty-two patients with secondary unilateral lip and nasal deformity were treated with asymmetric butterfly incision combined with vestibular V-Y advance flap,and the subjective and objective indicators after operation were observed.Results All incisions healed with primary healing and all cases were followed up for 3-12 months.Fifty-eight cases got symmetric nostril and alar,the sum of absolute value of the nostril differences between both sides 〈 3 mm.Two cases got symmetric nostril and alar,but the sum of absolute value of the nostril differences between both sides was 3.5 mm and 4.2 mm respectively.The alar relapsed again in 2 cases and the results were not satisfied,the sum of absolute value of the nostril differences between both sides 〉 5 mm.Conclusions The method of using the asymmetric butterfly incision combined with vestibular V-Y mucosa flap can reset the skin,cartilages and mucosa to the anatomic position effectively.