Rikimaru Hideaki, Kiyokawa Kensuke, Koga Noriyuki, Takahashi Nagahiro, Morinaga Keigo, Ino Kou
Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan.
J Craniofac Surg. 2008 Sep;19(5):1374-80. doi: 10.1097/SCS.0b013e3180f6117d.
In adult cases of bilateral cleft lip nasal deformity, an esthetically satisfying result can not be obtained only by manipulation inside the nose with the nasal tip pointing upward. The nasal tip should be made in a more anterior direction for nasal esthetic improvement. Additional tissue beyond the nose is needed, and the forked flap is a useful method in such cases. However, the blood circulation of long and narrow flaps containing the scar, especially after open rhinoplasty, is unstable. We have developed a new long and narrow forked flap that has a more stable blood circulation. The forked flap was made using two subcutaneous pedicles attached to the periphery of the each flap. We applied this flap to five adult cases of bilateral cleft lip nasal deformity. Four of the cases had the scar associated with the flying bird incision, and one case required no treatment after the primary repair. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the profile was esthetically improved. In the final stage of correction for adult cases of bilateral cleft lip nasal deformity, this method, making maximum use of the tissue containing the scar in not only the white lip but also the vermilion, is very effective. It is very important to obtain nasal esthetic improvement for the adult patient with bilateral cleft lip nasal deformity.
在成人双侧唇裂鼻畸形病例中，仅通过向上提拉鼻尖在鼻腔内进行操作，无法获得美观满意的效果。为改善鼻部美观，鼻尖应向前方调整。这需要鼻外的额外组织，而叉状皮瓣在这类病例中是一种有用的方法。然而，包含瘢痕的狭长皮瓣，尤其是在开放性鼻整形术后，其血液循环不稳定。我们开发了一种血液循环更稳定的新型狭长叉状皮瓣。该叉状皮瓣利用附着于每个皮瓣周边的两个皮下蒂制作而成。我们将此皮瓣应用于5例成人双侧唇裂鼻畸形病例。其中4例有与飞鸟形切口相关的瘢痕，1例在一期修复后无需治疗。所有皮瓣均成活，未出现部分坏死迹象。在所有病例中，鼻尖向前突出，鼻小柱适度延长，侧面轮廓在美观上得到改善。在成人双侧唇裂鼻畸形矫正的最后阶段，这种充分利用不仅白唇而且红唇中含瘢痕组织的方法非常有效。对于患有双侧唇裂鼻畸形的成年患者而言，实现鼻部美观改善非常重要。
