应用三叶皮瓣修复鼻尖部皮肤缺损

Trilobed flaps for reconstructio n of nasal tip defects

目的：探讨应用三叶皮瓣修复鼻尖部皮肤缺损的经验与体会。方法23例鼻尖部肿瘤手术切除后皮肤缺损患者，缺损面积1.5 cm ×1.5 cm～2.5 cm ×2.5 cm。根据创面的位置及大小，设计三叶皮瓣进行修复，各瓣叶之间的角度保持在45°～50°，第1个瓣叶与创面的大小相等，第2、3个瓣叶依次缩小，修复过程中尽量保持鼻部美容亚单位的完整性，并利用天然皱褶隐藏瘢痕线。结果23例的皮瓣术后全部成活，切口Ⅰ期愈合。23例术后随访6个月至2年，皮瓣与周围皮肤组织的色泽、质地及厚度相近，切口瘢痕隐蔽，鼻翼、鼻孔、鼻小柱及周围器官均未发生畸形，形态满意，功能良好。结论三叶皮瓣能有效修复鼻尖部较大面积皮肤缺损并取得良好的形态与功能效果。

Objective To evaluate the performance of trilobed flaps for reconstruction of nasal tip defects. Methods Totally, 23 patients with nasal tip defects after tumor resection were enrolled into this study. Skin defects varied from 1.5 cm × 1.5 cm to 2.5 cm × 2.5 cm in size. According to the location and size of skin defects, trilobed flaps were designed, and the angle between two lobes ranged from 45° to 50°. The size of the first lobe was approximately equal to that of the skin defect, while the size of the second and third lobes decreased successively. During flap design, the integrity of nasal subunits was sufficiently considered, and the incision lines were placed along the boundary lines of the nasal subunit as far as possible, so as to conceal the incision scar with natural skin folds. Results After the operation, skin flaps survived with primary healing of incisions in all the patients. After 6 - 24 months of follow up, the color, texture and thickness of flaps were similar to those of their surrounding skin, and incision scars were inconspicuous. No malformation occurred in the nasal ala, nostril, nasal columella or surrounding organs, and satisfactory nasal appearance and function were achieved. Conclusion Trilobed flaps can be used to effectively repair relatively large skin defects of the nasal tip with satisfactory nasal appearance and function.