Scuderi Nicolò, Ribuffo Diego, Chiummariello Stefano
Department of Plastic and Reconstructive Surgery, University of Rome La Sapienza, Rome, Italy.
Plast Reconstr Surg. 2005 Apr 15;115(5):1259-65. doi: 10.1097/01.prs.0000156774.66841.0f.
The authors review their 10-year experience with the nasal chondromucosal flap for total and subtotal upper eyelid reconstruction.
After several modifications, the flap is now designed along the lateral nasal wall and is based on the terminal branch of the dorsal nasal artery, to include the subcutaneous tissues down to the periosteum and the cranial portion of the upper lateral cartilage. A skin graft is applied for cutaneous coverage. The flap can be harvested unilaterally or contralaterally.
Fifteen patients, aged 50 to 75 years, have been operated on with this technique for total or subtotal defects of the upper eyelid since 1993. Follow-up included assessment of position, closure, presence of epiphora, length of palpebral rim, eyelid opening, levator function, aesthetic balance, and donor-site morbidity. The flap result was viable in every patient, without total or partial necrosis. Static parameters were within normal ranges, and 8 to 18 mm of levator function (mean, 13 mm) was achieved.
Compared with other frequently used techniques, namely, the Cutler-Beard advancement flap and the Mustarde lid switch flap, this procedure is a one-stage operation, does not damage the lower lid, and provides a thin, mobile eyelid with an anatomically complete reconstruction. The nasal chondromucosal flap has thus become the authors' standard for large full-thickness defects of the upper lid.
作者回顾了他们使用鼻软骨黏膜瓣进行上睑全层及次全层重建的10年经验。
经过多次改良，现在该皮瓣沿鼻侧壁设计，以鼻背动脉终末支为蒂，包含直至骨膜的皮下组织及上外侧软骨的颅部。采用植皮覆盖皮肤缺损。该皮瓣可单侧或双侧切取。
自1993年以来，15例年龄在50至75岁的患者接受了此项技术治疗上睑全层或次全层缺损。随访内容包括评估位置、闭合情况、溢泪情况、睑缘长度、眼睑开合度、提上睑肌功能、美学平衡及供区并发症。每个患者皮瓣均存活，无全部或部分坏死。静态参数在正常范围内，提上睑肌功能达到8至18毫米（平均13毫米）。
与其他常用技术，即卡特勒 - 比尔德推进皮瓣和马斯塔德眼睑转位皮瓣相比，该手术为一期手术，不损伤下睑，能提供一个薄且可活动的眼睑，实现解剖学上的完整重建。因此，鼻软骨黏膜瓣已成为作者治疗上睑大面积全层缺损的标准术式。
