Division of Dermatologic Surgery, Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.
J Am Acad Dermatol. 2011 Jul;65(1):97-105. doi: 10.1016/j.jaad.2011.01.019. Epub 2011 Apr 17.
The paramedian forehead flap (PFF) is a common method of reconstruction for large nasal defects. Generally, surgeons divide this flap at 3 weeks. This delay can result in a significant decrease in the quality of life for these patients.
We sought to describe the indications and technique for trunk division at 1 week after PFF reconstruction, and to evaluate the clinical outcomes.
This was a case series of consecutive patients undergoing primarily nasal defect reconstruction by PFF repair during the past 6 years. We explored medical record review of associated complications, patient rating of impact on quality of life and final results of repair, and patient preferences regarding time to flap division.
A total of 26 patients underwent accelerated trunk division at a mean of 7.2 days. Of these, 27% had a history of tobacco use, 23% were diabetic, and 19% had cartilage grafts used in their repairs. None developed necrosis and other complications were minor. Most patients considered their trunk very disfiguring, preventing them from daily activities. This was especially true for those younger than 70 years. Of all patients, 94% preferred trunk division at 1 week, rather than 3 weeks.
Retrospective study design and number of patients were limitations.
PFF trunk division at 1 week is safe and effective for resurfacing of large nasal defects, including those reconstructions that require cartilage. Younger and healthier patients may be the most ideal candidates for accelerated division given the greater negative impact of an intact trunk on their lives.
正中额部皮瓣（PFF）是修复大鼻缺损的常用方法。通常，外科医生在术后 3 周对皮瓣进行分割。这种延迟会导致这些患者的生活质量显著下降。
我们旨在描述 PFF 修复后 1 周进行躯干分割的适应证和技术，并评估临床结果。
这是一项连续病例系列研究，回顾性分析过去 6 年期间接受 PFF 修复的原发性鼻缺损患者。我们探讨了与并发症相关的病历回顾、患者对生活质量影响的评分以及修复的最终结果、以及患者对皮瓣分割时间的偏好。
共有 26 例患者平均在 7.2 天进行了加速的躯干分割。其中，27%有吸烟史，23%为糖尿病患者，19%的患者在修复中使用了软骨移植物。没有发生坏死，其他并发症较轻。大多数患者认为自己的躯干非常难看，妨碍了日常活动。这在 70 岁以下的患者中尤为明显。所有患者中有 94%的人更喜欢在术后 1 周而不是 3 周时进行躯干分割。
回顾性研究设计和患者数量有限是本研究的局限性。
PFF 躯干分割在 1 周时用于大鼻缺损的修复是安全有效的，包括那些需要软骨重建的病例。对于年轻和健康的患者，由于完整的躯干对其生活的负面影响更大，因此可能是加速分割的最理想候选者。
