局部皮瓣在鼻部缺损修复中的精准运用——实用与功能的平衡

Accurate Repair of Partial Nasal Defects with Local Flaps—The Balance between Beauty Appearance and Function

目的 探讨局部皮瓣修复外鼻不同亚单位缺损的效果,总结最佳皮瓣修复方式。方法 选择2015年1月至2020年11月我科收治的外鼻皮肤肿瘤切除后行皮瓣修复的患者45例,其中良性肿瘤11例(棘皮瘤3例,脂溢性病变6例,色素细胞瘤2例),恶性肿瘤34例(基底细胞癌19例,鳞状细胞癌14例,恶性黑色素瘤1例)。肿瘤位于鼻尖9例,鼻翼13例,鼻根6例,鼻背9例,鼻唇沟8例。均行病变切除+不同皮瓣修复外鼻不同亚单位缺损。结果 本组45例鼻部缺损均一期皮瓣修复,其中双叶皮瓣修复14例,旋转易位皮瓣修复19例,滑行推进皮瓣修复9例,A-T皮瓣修复3例。所有切口一期愈合,皮瓣血运良好。均获随访,随访时间6~40个月。皮瓣色泽良好,无色素沉着,鼻外形正常,鼻通气功能良好,供受区疤痕不明显。随访期间肿瘤无复发。结论 对于外鼻不同亚单位的缺损,应根据鼻部解剖特点、缺损部位、面积、是否损伤通气功能等精准选择合适的局部邻近皮瓣修复,从而在根治肿瘤的基础上获得满意的外形及功能效果。

Objective To assess the effects of different nasal local flaps in repairing the defects of different subunits of the external nose and to provide the most effective method. Methods A total of 45 cases with external nasal neoplasms underwent radical resection and nasal flaps repaired from January 2015 to November 2020 in our department were selected and analyzed retrospectively, including 11 cases of benign tumor(3 of acanthoma, 6 of seborrheic lesion and 2 of chromocytoma) and 34 cases of malignant tumor(19 of basal cell carcinoma, 14 of squamous cell carcinoma and 1 of malignant melanoma). The focus located in nasal tip in 9 cases, nasal alar in 13 cases, nasal root in 6 cases, nasal dorsum in 9 cases and nasolabial groove in 8 cases. Lesion excision and subunit defects repair of external nose were performed with different flaps. Results All nasal defects were repaired by one-stage skin flaps, including 14 of bilobed flaps, 19 of rotary transposition flaps, 9 of sliding advancement flaps and 3 of A-T flaps. All incisions healed in one-stage and blood supply of the flaps achieved good. All patients were followed up for 6 to 40 months. The skin flap appeared good color, normal nose shape and nasal ventilation function without pigmentation and obvious scar in the donor and recipient area. There was no recurrence during the follow-up period. Conclusion For the defects of different subunits of the external nose, the appropriate local adjacent flaps would be selected accurately according to the anatomical characteristics of the nose, the location and area of the defect and the ventilation function damaged or not, so as to obtain a satisfactory appearance and functional effect on the basis of radical treatment of the tumor.