组合皮下组织蒂皮瓣修复11例鼻翼全层缺损疗效观察

Clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects of 11 patients:a clinical observation

目的探讨组合皮下组织蒂皮瓣对鼻翼全层缺损的修复效果。方法回顾性分析2019年8月至2020年9月杭州市第三人民医院皮肤外科收治的11例鼻翼基底细胞癌患者临床资料, 女6例, 男5例, 年龄56~87岁(平均70岁)。患者肿瘤切除后均形成鼻翼全层缺损, 先沿面颊部内侧设计一个皮瓣, 翻转180°修复鼻黏膜形成衬里, 再沿同侧鼻唇沟方向设计一个皮下组织蒂皮瓣, 修复继发缺损及肿瘤术后缺损处的外层皮肤。结果术后缺损平均直径1.8 cm(范围1.5~2.5 cm), 衬里直径平均0.9 cm(范围0.6~1.5 cm)。7 d后拆线, 伤口愈合, 无并发症, 皮瓣全部成活, 效果满意。随访1~13个月, 平均6个月, 瘢痕成熟后, 患者对美容效果满意。此外, 在随访期间未见肿瘤复发。结论复合皮下组织蒂皮瓣修复鼻翼全层缺损安全有效, 具有供区隐蔽性好、颜色匹配度高、Ⅰ期手术修复的优点。

Objective To investigate clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects.Methods Clinical data were collected from 11 patients with basal cell carcinoma of nasal ala in Department of Dermatologic Surgery,the Third People's Hospital of Hangzhou from August 2019 to September 2020,and analyzed retrospectively.There were 6 females and 5 males,aged 70 years in average(range,56-87 years).After tumor resection,full-thickness nasal alar defects were formed,a flap was designed along the inner side of the cheek and turned by 180 degrees to repair the nasal mucosal lining;then,a subcutaneous pedicled flap was designed along the ipsilateral nasolabial fold to repair the outer secondary defects and postoperative defects.Results The mean diameter of postoperative defects was 1.8 cm(range,1.5-2.5 cm),and the mean diameter of the nasal lining was 0.9 cm(range,0.6-1.5 cm).Seven days after the operation,stitches were removed,wounds healed without complications,and all flaps survived with a satisfactory appearance.The follow-up period ranged from 1 to 13 months(average,6 months).After scar maturation,all patients were satisfied with the aesthetic outcome.No tumor recurrence was observed during the follow-up period.Conclusion The composite subcutaneous pedicled flap is safe and effective for the repair of full-thickness nasal alar defects,and has advantages of a well-hidden donor site,good color match,and stage-Ⅰ operation for reconstruction.