鼻背眉间皮瓣修复鼻背鼻尖部皮肤缺损的临床效果

Clinical effects of nasal glabellar flap on reconstruction of nasal dorsal and tip

目的介绍鼻背眉间皮瓣一期修复鼻背鼻尖部皮肤缺损的经验。方法2010年1月至2018年1月,南京医科大学第一附属医院整形烧伤科收集鼻背鼻尖部皮肤组织缺损17例,其中男7例,女10例,年龄38~76岁。鼻尖部缺损9例,鼻背缺损8例。缺损面积15mm×15mm至30mm×26mm。用眉间皮肤的松弛特性设计鼻背眉间皮瓣旋转修复鼻背鼻尖的皮肤缺损,减少皮瓣供区张力使创面直接缝合闭合。结果17例患者创面均一期修复,皮瓣全部成活。随访1~6个月,原有肿瘤皮损均无复发,修复创面的组织与创面周围组织协调匹配,皮肤颜色、厚度、质地与周围基本一致,鼻外形未受影响,均达到了较佳的视觉效果。结论鼻背眉间皮瓣与鼻部色泽、厚度、质地相匹配,修复鼻背鼻尖的皮肤缺损面积的直径最大可达30mm,是鼻背鼻尖组织缺损时优先考虑的修复组织之一。

Objective To introduce an excellent one-stage procedure for repairing defects of the middle and distal part of the nose:nasal dorsal glabellar flap.Methods According to the size,shape and location of nasal defect,homologous nasal dorsal glabellar flap was selected to cover the nasal defect in 17 cases.Among 17 cases,there were 7 men and 10 women,with age of 38 to 76 years.The locations were nasal tip in 9 cases and dorsum of nose in 8 cases,The area of the defect ranged from 15 mm×15 mm to 30 mm×26 mm.The nasal dorsal glabellar flap,which received a versatile axial blood supply from branches of the facial artery and ophthalmic artery,took tissue from the lax glabellar skin and might appear to be too aggressive for closure of a distal nasal or mid-nasal defect.However,because its design was primarily that of a rotation flap with a back-cut in the glabella region,it was greater than the primary defect in order to maximize tissue movement and decreased wound closure tension at the flap donor site.The secondary defect of donor site was directly sutured.Results The nasal defect was successfully repaired in all patients,and the all flaps survived.The patients were available for follow-up of 1 to 6 months,no tumor recurrence occurred,and the repaired tissue were good match with surrounding tissue in color,thickness and texture,good nasal contour was obtained and no secondary deformity occurred,and therefore the cosmetic results were satisfactory.Conclusions The nasal glabellar flap has evolved into a choice flap for nasal defects of cover since it provides local skin with an exact color,thickness,and texture match for the nasal skin.It allows large reconstructions for up to 30 mm defects leaving minimal scars.It represents an interesting alternative for the reconstruction of defects of the nasal tip or supra tip of the nose.