Unité de chirurgie plastique et orbito-palpébrale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2011 Jan;128(1):1-6. doi: 10.1016/j.anorl.2010.10.005. Epub 2011 Jan 13.
Surgical reconstruction of the nasal tip is a very delicate procedure, as it must rebuild three different anatomical planes: mucosa, cartilage and skin with functional and aesthetic requirements. This procedure is even more difficult in burns patients, due to more limited donor sites and poor skin quality. Numerous flap options are available to reconstruct defects of the tip of the nose. The authors report their experience of nasal alar reconstruction by a scar tissue remodelling technique using a rolled dermal flap with overlying full-thickness skin graft.
The medical charts of seven patients (five women and two men with a mean age of 30) treated between 1991 and 2006 were retrospectively reviewed. Six patients presented sequelae of a facial burn and one patient had congenital facial hemiagenesis.
Reconstruction was bilateral for all burns patients and unilateral for the patient with facial hemiagenesis. The skin graft was raised from the medial aspect of the forearm in four cases, the retroauricular region in two cases and the groin in one case. One patient required a second surgical procedure for necrosis of the nasal tip. No nasal obstruction was reported with a mean follow-up of five years (range: six months to 15 years).
The rolled dermal flap with overlying full-thickness skin graft is a simple and reliable procedure for reconstruction of the nasal alae. Filling of the nasal alae defect and reconstruction of all anatomical planes are achieved in a single surgical procedure. The aesthetic and functional results were satisfactory, with minimal scarring of the donor site. This technique is very suitable for the treatment of burn sequelae and can also be used to treat nasal hemiagenesis and nasal mutilation by biting or facial trauma.
鼻尖的外科重建是一个非常精细的过程，因为它必须重建三个不同的解剖平面：黏膜、软骨和皮肤，同时满足功能和美学要求。在烧伤患者中，由于可供选择的供区更有限且皮肤质量较差，这一过程更加困难。有许多皮瓣可供选择来重建鼻尖的缺损。作者报告了他们使用带有全厚皮片覆盖的卷式真皮皮瓣进行疤痕组织重塑技术重建鼻翼的经验。
回顾性分析了 1991 年至 2006 年间治疗的 7 例患者（5 名女性和 2 名男性，平均年龄 30 岁）的病历。6 例患者存在面部烧伤后遗症，1 例患者存在先天性面偏侧发育不全。
所有烧伤患者均为双侧重建，1 例面偏侧发育不全患者为单侧重建。4 例患者的皮片取自前臂内侧，2 例取自耳后，1 例取自腹股沟。1 例患者因鼻尖坏死需要进行第二次手术。所有患者均未报告出现鼻阻塞，平均随访 5 年（6 个月至 15 年）。
带全厚皮片的卷式真皮皮瓣是重建鼻翼的一种简单可靠的方法。在单一手术中可以同时填充鼻翼缺损并重建所有解剖平面。美学和功能效果满意，供区瘢痕最小。这种技术非常适合治疗烧伤后遗症，也可用于治疗由咬噬或面部创伤导致的鼻偏侧发育不全和鼻畸形。
