鼻部软组织缺损不同方法修复的临床效果

Clinical efficacy of the different repairs of nasal tissue defects

目的探讨鼻部软组织缺损不同方法修复的临床效果。方法共收治17例鼻部软组织缺损患者。对不同鼻部软组织缺损分别应用额部皮瓣再造全鼻或部分鼻再造术，耳廓组织瓣游离移植术，Medpor支架植入术，鼻唇沟岛状皮瓣转移术，全厚植皮，额部或面颊部扩张器埋置扩张皮瓣修复，自体鼻中隔或肋软骨取出移植，局部任意皮瓣转移术，鼻小柱延长术等进行治疗。结果随访时间2个月至6年。4例鼻再造患者术后外形满意，2例Medpor支架外露，经修整后痊愈；耳廓复合组织游离移植4例中3例完全成活，1例坏死；鼻唇沟岛状皮瓣7例中6例完全成活，1例部分坏死；全厚植皮2例完全成活；扩张器埋置4例，扩张效果良好，达到预期需要皮瓣量；随意型皮瓣转移5例，皮瓣均完全成活，鼻小柱延长2例效果好。5例患者经2次或2次以上手术完成修复，17例患者随访期间均对手术效果满意。结论临床上鼻部组织缺损患者缺损可为单一鼻部亚单位缺损，也可合并多个亚单位，可利用皮瓣转移修复、耳廓组织移植、皮肤移植、支撑体植入和全鼻再造等手术来进行修复。

Objective To analyze the clinical efficacies of repairing nasal tissue defect. Methods The 17 cases of nasal defects were repaired. According to the difference of nasal tissue defect, different treatments were used, which included total nose reconstruction or partial nose reconstruction with forehead flap, transplantation of auricle composite flap, medpor framework implantation, nasolabial flap transferring, fulbthickness skin graft, skin expander embedded in the forehead or cheek, extraction of costal cartilage or nasal septal cartilage and columella lengthening. Results The follow-up was from 2 months to 6 years. Four cases with nose reconstruction had a good appearance, but exposure of framework was found in two of them, which was healed after repairing. Auricle composite flaps were completely survived in three cases and necrosis was found in one case. Six of seven cases had a completely survived nasolabial flaps, and the remaining one had a partial necrosis. The full-thickness skins were survived in the two cases. The four cases who received expander embedded had a expectant result. Random flaps were completely survived in five cases. Columella lengthening in two cases had a stable result. Five cases had received two or more than two times operations. During the follow-up pe- riod, the 17 cases were satisfied with the operative results. Conclusions The nasal tissue defect not only presents in a single nasal subunit, but also happens in multi-subunits. Flap transferring, graft of auricle composite tissue, medpor framework implantation and nose reconstruction could be used in the repairing procedures.