Moore Eric J, Strome Scott A, Kasperbauer Jan L, Sherris David A, Manning Lance A
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902, USA.
Laryngoscope. 2003 Dec;113(12):2078-85. doi: 10.1097/00005537-200312000-00004.
OBJECTIVES/HYPOTHESIS: Total and near-total nasal reconstruction requires the surgeon to replace external nasal cover, skeletal support, and internal nasal lining. The successful result must re-create the form and function of the original nose. In large defects, traditional sources of internal lining may be unavailable. The study describes the recreation of nasal lining in three patients with extensive nasal defects with vascularized radial forearm tissue.
Retrospective review of three patients who underwent nasal reconstruction with radial forearm for internal lining, costal cartilage grafts for skeletal support, and paramedian forehead flap for cover.
The charts of three patients who underwent total nasal reconstruction with radial forearm tissue transfer for lining were retrospectively reviewed. The technique was evaluated. The authors present a method for internal lining reconstruction in extensive nasal defects. They discuss the advantages and disadvantages of this method.
Three patients underwent successful total nasal reconstruction with radial forearm tissue transfer for lining, costal cartilage for skeletal support, and paramedian forehead flap. None of the patients had adequate septal mucosa or nasal subunit skin to support mucosal rotation grafts or epithelial turn-in flaps. All patients have completed reconstruction and have satisfactory nasal form and function. Loss of the lining flap or graft loss did not occur.
Vascularized radial forearm tissue supplies ample quantities of skin to recreate nasal lining. The tissue provides excellent support of graft material, and it prevents contracture of the covering flap. Because of its bulk and donor site morbidity, free forearm tissue transfer should not be considered for reconstruction of smaller defects when another lining flap will suffice.
目的/假设：全鼻及近全鼻重建要求外科医生替换鼻外覆盖物、鼻支架及鼻内衬里。成功的重建必须重塑原鼻的形态与功能。在大面积缺损时，传统的内衬里来源可能无法获取。本研究描述了使用带血管蒂的桡侧前臂组织为三名鼻大面积缺损患者再造鼻内衬里的情况。
对三名患者进行回顾性研究，这三名患者接受了以桡侧前臂组织作为内衬里、肋软骨移植作为鼻支架、正中旁前额皮瓣作为覆盖物的鼻重建手术。
对三名采用桡侧前臂组织转移进行内衬里重建的全鼻重建患者的病历进行回顾性研究。对该技术进行评估。作者介绍了一种用于大面积鼻缺损内衬里重建的方法。他们讨论了该方法的优缺点。
三名患者采用桡侧前臂组织转移进行内衬里重建、肋软骨作为鼻支架、正中旁前额皮瓣进行覆盖，均成功完成全鼻重建。所有患者均无足够的鼻中隔黏膜或鼻亚单位皮肤来支撑黏膜旋转移植片或上皮内卷皮瓣。所有患者均已完成重建，鼻的形态和功能令人满意。未发生内衬里皮瓣丢失或移植片丢失的情况。
带血管蒂的桡侧前臂组织可提供充足的皮肤来再造鼻内衬里。该组织为移植材料提供了良好的支撑，并可防止覆盖皮瓣挛缩。由于其体积较大且供区存在一定并发症，当有其他内衬里皮瓣可用时，对于较小缺损的重建不应考虑采用游离前臂组织移植。
