鼻亚单位原则在鼻外伤软组织缺损一期修复中的应用

Application of aesthetic sub-unit principle in Single-stage Soft tissue reconstruction of a traumatic nasal defects

目的探讨鼻亚单位原则在鼻外伤软组织缺损一期修复中的临床意义。方法我院2007年5月至2015年3月收治19例鼻外伤后皮肤缺损的患者，均行一期修复手术。根据鼻部缺损的部位、大小、深度，选择不同的修复方法，其中全厚皮肤移植1例，额鼻皮瓣1例，旋转双叶皮瓣2例，鼻唇沟皮瓣8例，鼻唇沟折叠皮瓣2例，耳廓复合组织游离移植2例，颞区眼轮匝肌蒂皮瓣3例。术后随访3-27个月，根据修复后的鼻外形和色泽及瘢痕情况来判断修复和再造效果。结果19例患者皮瓣及皮片全部成活，其中1例鼻唇沟折叠皮瓣出现感染，切口Ⅱ期愈合，其余切口均Ⅰ期愈合；2例耳廓复合组织游离移植，早期出现移植物颜色灰暗，5个月后皮肤色泽渐趋正常，鼻唇沟折叠皮瓣修复鼻翼区的弧度及曲线略欠佳。所有患者对手术结果表示满意。结论运用鼻亚单位原则进行皮瓣一期修复鼻部外伤后缺损，手术效果好。

Objective To evaluate the cosmetic outcomes of nasal aesthetic sub-unit principle. Methods From May 2007 to March 2015,19 patients with traumatic soft tissue defects of nose had a Single-stage reconstruction with suitable reconstructive method. Full-thick- ness skin transplantation was performed in 1 case,forehead nasal flap in 1 case,bilobed flaps in 2 cases,nasolabial flaps in 9 cases,a folded nasolabial flap in 2 cases, free auricular composite flap in 1 case, the temporal flap pedicled with the orbicular oculi muscle in 3 cases. All pa- tients were followed up for 5 ~ 27 months, evaluation items were recorded and analyzed. Results Skin transplantation and local flap were all survived. But 1 case with nasolabial flap infected was healing by second intention,the rest were primary healing,free auricular composite flap was gloomy, and it became normal 5 months after operation. The radian and the curve of the folded nasolabial flap to repair the nasal alar areawere slightly poor. Condusion Good aesthetic effets come from nasal aesthetic sub-unit principle in Single-stage soft tissue reconstruction of a traumatic nasal defects.