Fudem Gary M, Montilla Richard D, Vaughn Carolyn J
Department of Surgery, Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Ann Plast Surg. 2010 May;64(5):645-8. doi: 10.1097/SAP.0b013e3181c925fc.
The paramedian forehead flap has become the standard of care for major nasal reconstruction. The classic procedure involves a second-stage operation to divide and inset the external pedicle. We present our experience in a clinical series using single-stage forehead flap reconstruction. Our indications include elderly patients, pediatric patients treated during mission trips, and any patient in whom an external pedicle or two-stage procedure is problematic. From 2008 to 2009, 9 patients underwent a single-stage forehead flap. The majority had defects after excision of skin cancer. Our modification involves removal of radix and proximal nasal skin and fat and deepithelialization of the proximal pedicle to allow inset without excess compression or kinking. This modification avoids the sequelae of an external pedicle, which include bleeding, dressings, the inability to wear eyeglasses, and the patient's reluctance to appear in public. It safely provides acceptable results and avoids a mandatory secondary procedure.
旁正中前额皮瓣已成为大型鼻再造的标准治疗方法。经典手术包括二期手术来分离并植入外部蒂。我们介绍我们在一系列采用单期前额皮瓣重建的临床病例中的经验。我们的适应症包括老年患者、在医疗援助任务中接受治疗的儿科患者以及任何存在外部蒂或二期手术存在问题的患者。2008年至2009年，9例患者接受了单期前额皮瓣手术。大多数患者在皮肤癌切除后存在缺损。我们的改良方法包括切除鼻根和近端鼻皮肤及脂肪，并对近端蒂进行去上皮化处理，以便在植入时避免过度压迫或扭结。这种改良避免了外部蒂带来的一系列问题，包括出血、敷料、无法佩戴眼镜以及患者不愿在公共场合露面。它安全地提供了可接受的效果，并避免了强制性的二期手术。
