双Z复合组织瓣联合唇鼻肌肉重建修复单侧唇裂术后继发鼻畸形的效果

Efficacy of combined double composite tissue Z-plasty with nasolabial anatomical reconstruction on nasal deformity in secondary unilateral cleft lip

目的探讨双Z复合组织瓣联合唇鼻肌肉重建修复单侧唇裂术后继发鼻畸形的效果。方法2017年4月至2021年4月,徐州市中心医院整形美容科对单侧唇裂术后继发鼻畸形的患者25例(男6例、女19例,年龄11~35岁,平均18.1岁),用双Z复合组织瓣联合唇鼻肌肉重建的方法进行修复。术后随访3~24个月,通过调查问卷评分表对手术效果进行评估。结果术后25例患者均未出现血肿、感染及皮瓣坏死等并发症。术后评估平均鼻小柱长度由术前14.2 mm改善至术后20.2 mm。术前患侧鼻小柱高度与鼻翼基部宽度的平均比值为0.18,术后为0.30。术后基底照和正位照显示鼻孔、鼻小柱、鼻槛外形明显改善。调查问卷结果显示,术后效果非常好20例,术后效果良好4例,1例患侧鼻孔大小形态改善欠佳,术后12个月进行手术翻修,彻底松解梨状孔周围异位肌肉,再次修复术后效果较好。术后满意率为96%。结论双Z复合组织瓣联合唇鼻肌肉重建修复单侧唇裂术后继发鼻畸形,对单侧唇裂鼻畸形的软骨、肌肉和皮肤层有较好的解剖学修复作用。方法安全、操作简便,患者满意度较高,值得临床应用。

Objective To investigate the repair of the severe nasal deformity in the unilateral cleft lip secondary with the methods in the composite tissue Z-plasty and the nasolabial anatomical reconstruction.Methods A total of 25 patients with severe nasal deformity due to secondary unilateral cleft lip underwent the reconstructive surgery using the technique of composite tissue Z-plasty and the nasolabial anatomical reconstruction for anatomical restoration of cartilage,muscle,and soft tissue layers.All patients were followed up for 3-24 months,with an average period of 7.6 months.The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results All the 25 patients had achieved satisfactory nostril shape and no other complications such as bleeding,infection and flap necrosis were recorded.A total of 25 patients were evaluated postoperatively.The average columella length was significantly improved from an average of 14.2 mm preoperatively to 20.2 mm postoperatively.The average ratio of the cleft side columella height to the alar base width was 0.18 preoperatively and 0.30 postoperatively.The postoperative basal and frontal views revealed a better shape of the nostrils,columella and nasal floor.GAIS questionnaires of 25 patients demonstrated that 20 patients reported great improvement,4 patients reported moderate improvement,1 patient had poor improvement in size and shape of the affected side nostril who undevwent the another repair of the rdure in 12 months postoperation.The ectopic muscles around the pear hole was completely released and the effect was good after repair.The satisfactory rate was 96%.Conclusions Combining the composite tissue Z-plasty with the nasolabial anatomical reconstruction allows for thorough anatomical restoration of cartilage,muscle,and skin layers in unilateral cleftlip nasal deformities.This single-step approach is a safe and technically easy therapeutic option that is associated with high patients′satisfaction.This method should be considered for promotion in clinic.