鼻唇沟皮瓣联合耳甲腔软骨移植修复鼻翼基底细胞癌术后缺损

APPLICATION OF NASOLABIAL FLAP AND EAR CARTILAGE IN REPAIRING DEFECTS AFTER NASAL ALA BASAL CELL CARCINOMA RESECTION

目的探讨鼻唇沟皮瓣联合耳甲腔软骨移植修复鼻翼基底细胞癌切除术后皮肤软组织缺损的疗效。方法 2012年1月-2014年8月,收治鼻翼基底细胞癌患者8例。男5例,女3例;年龄45~76岁,平均65岁。左侧鼻翼3例,右侧鼻翼5例。均存在鼻翼皮肤病损,反复破溃无好转。经病理检查确诊;确诊至该次手术时间为7~14 d,平均10 d。术中病变组织切除后缺损范围为1.5 cm×1.5 cm^2.0 cm×1.5 cm,采用大小为4.0 cm×1.5 cm^5.0 cm×2.0 cm的鼻唇沟皮瓣联合耳甲腔软骨移植修复。一期术后6个月行皮瓣断蒂并修薄术。结果术后皮瓣均顺利成活,创面Ⅰ期愈合。二期断蒂术中未见肿瘤复发,断蒂后切口Ⅰ期愈合。患者均获随访6个月。患侧鼻翼无塌陷,术区未见明显瘢痕。患者对鼻外形满意。结论鼻唇沟皮瓣联合耳甲腔软骨移植修复鼻翼基底细胞癌术后皮肤软组织缺损,具有操作简便、切口隐蔽且不遗留明显瘢痕、鼻翼外观较好的优点,但需行两期手术是其不足。

Objective To investigate the effectiveness of nasolabial flap and ear cartilage in repairing defects after nasal ala basal cell carcinoma resection. Methods Between January 2012 and August 2014, 8 patients with nasal ala basal cell carcinoma underwent tumor resection and defect repair with nasolabial flap and ear cartilage. Among the 8 patients, 5 were male and 3 were female, with an average age of 65 years（range, 45-76 years）. The left side and right side were involved in 3 cases and 5 cases respectively. Carcinoma confirmed by pathological examination in all patients. The time between first biopsy and resection was 7-14 days（mean, 10 days）. The defect ranged from 1.5 cm×1.5 cm to 2.0 cm×1.5 cm after tumor resection, and the size of nasolabial flaps ranged from 4.0 cm×1.5 cm to 5.0 cm×2.0 cm. The operations of cutting off the pedicle and thinning skin flap were performed at 6 months after first operation. Results All flaps survived. Incisions healed by first intention, and no related complication occurred. No carcinoma recurred after cutting off the pedicle. All patients were followed up for 6 months. All patients were satisfied with the nasal contour, symmetrical projection of the alar dome, and no obvious scar. Conclusion Nasolabial flap transfer and ear cartilage transplant method not only can repair the nasal ala defects, but also can avoid obvious scar and obtain good nasal ala contour profile. The shortcoming is that patients have to receive two operations.