邻近皮瓣修复皮肤恶性肿瘤切除后部分外鼻缺损

Locoregional Flap to Reconstruct Postoncological Partial Nasal Defects

目的探讨邻近皮瓣转移修复非黑色素瘤皮肤癌(NMSC)术后鼻缺损的术式选择。方法回顾性分析87例行鼻NMSC根治性切除+邻近皮瓣转移整复术患者的临床资料,其中67例(77.0%)缺损位于鼻下1/3,20例(23.0%)位于鼻中上2/3。缺损位于鼻翼37例,鼻背20例,鼻侧壁18例,鼻尖8例,累及多个鼻亚单位的复杂鼻缺损4例。分析总结患者鼻部的缺损特点、皮瓣类型及重建效果。结果鼻下1/3缺损的67例中,以鼻唇沟皮瓣修复51例,额部皮瓣8例,鼻背皮瓣7例,双叶皮瓣1例;鼻中上2/3缺损的20例中,以眉间皮瓣修复8例,双叶皮瓣7例,鼻唇沟皮瓣5例;4例复杂鼻缺损均以额部皮瓣修复,修复效果满意,术后随访2~24个月,无明显继发畸形。结论以邻近皮瓣转移修复皮肤肿瘤切除后的鼻缺损可获得可靠的手术效果。

Objective To introduce the algorithm for the selection of locoregional flaps in the reconstruction of nasal defects following resection of nonmelanoma skin cancer(NMSC).Methods In this retrospective study,a total of 87 cases who underwent locoregional flap reconstruction following NMSC resection were enrolled.In this series,67 cases(77.0%)were with defects located on the distal third of nose and 20 cases(23.0%)had defects on proximal two thirds,with 37 defects at alae,20 at dorsum,18 at sidewalls,8 at tip and 4 involving multiple subunits.Medical records were reviewed for the characteristics of nasal defects,type of flaps,complications and aesthetic outcomes.Results Among the 67 defects on distal third of nose,51 were reconstructed with nasolabial flap,8 with paramedian forehead flap,7 with dorsonasal flap,and 1 with bilobed flaps.Among the 20 nasal defects on the proximal two thirds,8 were reconstructed with glabella flap,7 with bilobed flaps,and 5 with nasolabial flap.All the 4 complex defects involving multiple nasal subunits were reconstructed with paramedian forehead flap.The surgical outcomes were satisfactory and within the time ranging from 2 months to 2 years,no secondary distortion was observed.Conclusion Locoregional flaps are ideal options for nasal reconstruction in postoncological defects and different locoregional flaps present as optimal choices for nasal defects of distinct locations and sizes.