带蒂上唇黏膜瓣修复鼻整形术后鼻中隔黏膜缺损的回顾性研究

A retrospective study of pedicled upper lip mucosal flap in repairing nasal septal mucosa defect after rhinoplasty

目的探讨带蒂上唇黏膜瓣修复鼻整形术后鼻中隔黏膜缺损的手术效果。方法回顾性分析2016年1月至2022年10月中南大学湘雅二医院整形美容(烧伤)外科收治的鼻整形术后鼻中隔黏膜缺损的患者资料。依据患者病史特点及创面情况,采用带蒂上唇黏膜瓣进行修复。沿上唇系带旁1 cm处设计皮瓣蒂部,基于创面大小切取合适皮瓣,切取皮瓣层次达口轮匝肌浅层;剥离龈颊沟与鼻腔之间的上唇隧道;将带蒂上唇黏膜瓣掀起后通过上唇隧道转移至鼻腔;调整皮瓣位置使其充分覆盖缺损创面后用5-0可吸收线缝合固定。于术前及术后6个月采用视觉模拟评分法(VAS)及鼻阻塞症状评估(NOSE)量表指导患者进行满意度及鼻堵塞症状评估,其中,VAS总分10分,评分越高表示患者越满意;NOSE量表包括5个项目,每个项目评分为0~4分,分别表示根本没有此症状、很轻、中等、比较严重和非常严重。VAS及NOSE量表得分采用±s表示,术前后比较采用配对样本t检验;NOSE量表的得分分布采用例数表示,术前后比较采用Mann-Whitney U检验。结果共纳入15例女性患者,年龄(27.6±2.9)岁(23~33岁);11例术前有软骨外露,组织缺损面积为0.9 cm×0.5 cm~1.5 cm×0.7 cm;9例既往有吸烟史;9例经历过植皮手术,8例经历过鼻腔黏膜转移术。术中皮瓣切取面积为4.0 cm×1.2 cm~7.0 cm×1.5 cm。术后恢复良好,皮瓣均顺利成活,未出现感染、血肿、伤口裂开、皮瓣坏死。随访(8.2±2.1)个月(6~12个月)。患者术后VAS评分[(7.73±0.88)分]较术前[(1.86±0.74)分]增加,差异有统计学意义(P<0.01)。患者术后NOSE量表评分[(4.66±1.71)分]较术前[(10.73±2.68)分]减少,差异有统计学意义(P<0.01);其中,鼻部不通气或不透气(2例vs.15例)、鼻塞或鼻堵(1例vs.14例)以及在运动或用力时感觉鼻吸气不够用(4例vs.14例)项目术后评分≥2分的患者分布较术前明显减少,差异有统计学意义(P均<0.01)。结论应用带蒂上唇黏膜瓣修复鼻整形术后严重鼻中隔黏膜缺损的效果好,患者术后满意度高,鼻通气功能明显改善,且无严重并发症。

ObjectiveTo investigate the surgical effect of pedicled upper lip mucosal flap in repairing nasal septal mucosal defects after rhinoplasty.MethodsA retrospective analysis was performed from January 2016 to October 2022,the clinical data of patients with nasal septal mucosal defects after rhinoplasty were collected in the Department of Plastic and Aesthetic(Burn)Surgery at the Second Xiangya Hospital of Central South University.The pedicled upper lip mucosal flap was utilized for repair based on the patient’s medical history and wound condition.The pedicle of the flap was designed 1 cm adjacent to the frenulum of the upper lip,and an appropriate flap was incised based on the size of the wound,with dissection performed up to the superficial layer of the orbicularis oris muscle.The dissection establishes an upper lip tunnel that connects the gingival-buccal groove to the nasal cavity.The pedicled upper lip mucosal flap was elevated and transposed into the nasal cavity via the upper lip tunnel.The position of the flap was adjusted to ensure complete coverage and fixation of the nasal septal defect wound using 5-0 absorbable suture.The visual analogue scale(VAS)and the nasal obstruction symptom evaluation(NOSE)scale were utilized to facilitate patients’satisfaction evaluation and assessment of nasal obstruction symptoms before surgery and at 6 months post-surgery.The VAS total score was 10 points,with higher scores indicating greater levels of patient satisfaction.The NOSE scale comprises of 5 items,each assigned a score ranging from 0 to 4,denoting absence of symptoms,very mild presence,moderate intensity,relatively severe manifestation,and highly severe indication respectively.The measurement data of VAS and NOSE scores before surgery and at 6 months post-surgery was expressed by Mean±SD,using paired t-test.The score distribution of the NOSE scale was represented by the number of cases,using Mann-Whitney U test.ResultsThe study included a total of 15 female patients,with an average age of(27.6±2.9)years(ranging from 23 to 33 years).Eleven cases presented with preoperative cartilage exposure,and the size of tissue defect ranged from 0.9 cm×0.5 cm to 1.5 cm×0.7 cm.Nine patients had a history of smoking.Skin grafting was performed in 9 patients,while nasal mucosal metastasis was observed in 8 patients.The dimensions of the flap varied from 4.0 cm×1.2 cm to 7.0 cm×1.5 cm.The postoperative recovery was satisfactory,with successful survival of the skin flaps and no occurrences of infection,hematoma,wound dehiscence,or flap necrosis.The average duration of follow-up was(8.2±2.1)months(ranging from 6 to 12 months).The postoperative VAS score(7.73±0.88)was significantly higher compared to the preoperative score(1.86±0.74)(P<0.01).Additionally,the postoperative NOSE score(4.66±1.71)showed a significant decrease from the preoperative score(10.73±2.68),with a statistically significant difference(P<0.01).Among them,after surgery items of stuffy or unbreathable nose(2 cases vs.15 cases),nasal obstruction(1 case vs.14 cases),and feeling that the nose was not enough to breathe during exercise or exertion(4 cases vs.14 cases)scored≥2 points were significantly less than those before operation(all P<0.01).ConclusionThe utilization of pedicled upper lip mucosal flap in the reconstruction of severe nasal septal mucosal defects following rhinoplasty has proven to be highly effective.The postoperative satisfaction of patients is remarkably high,the ventilation function exhibits significant improvement,and no severe complications are observed.