Tucson, Ariz. From St. Joseph's Hospital.
Plast Reconstr Surg. 2012 Jan;129(1):92e-103e. doi: 10.1097/PRS.0b013e3182362226.
Most nasal reconstructions previously repaired with regional flaps require a revision to improve appearance and function. Many local flaps also create significant landmark and contour distortions, such as alar crease obliteration or nostril margin malposition.
Over 400 nasal reconstructions with regional tissues, primarily forehead flaps, and 100 local flap repairs were evaluated to identify the causes of failure of the primary repair, to classify late deformities, and to develop an approach to the late revision of a nasal reconstruction. Surgical timing, staging, incisional approaches, and operative technique were defined with the goal of restoring normal dimension, volume, position, projection, symmetry, skin quality, border outline, and contour.
Deformities can be classified as "minor," when overall dimension, volume, and position are satisfactory but nasal landmarks are imperfect, nostril margins are asymmetric, or the nostrils are small; or "major," when there is a significant failure to restore the basic fundamental character of the nose. It is bulky, shapeless, malpositioned and without landmarks. These characteristics determine incision sites, the extent of required flap reelevation, soft tissue excision and cartilage grafting, the number of stages, the use of secondary local flaps, surgical delay, and the need for reoperation with a second regional flap.
Revision is accomplished through new direct incisions and old peripheral border scars. Soft tissue excision and secondary cartilage grafts can effectively reestablish contour. Lining deficiencies are addressed by transferring discardable local excess skin from the nostril margin, columella, cheek, or upper lip to open the airway. If local tissues are inadequate, a second regional flap must be transferred to resurface or line the nose.
之前使用区域性皮瓣修复的大多数鼻重建术需要进行修复以改善外观和功能。许多局部皮瓣也会导致明显的标志和轮廓变形，例如鼻翼皱褶消失或鼻孔边缘错位。
评估了超过 400 例使用区域性组织（主要是额部皮瓣）和 100 例局部皮瓣修复的鼻重建术，以确定初次修复失败的原因，对晚期畸形进行分类，并制定鼻重建术的晚期修复方法。手术时机、分期、切口入路和手术技术都进行了定义，目标是恢复正常的维度、体积、位置、突出度、对称性、皮肤质量、边界轮廓和轮廓。
畸形可以分为“轻微”和“严重”。当整体维度、体积和位置满意，但鼻标志不完美、鼻孔边缘不对称或鼻孔较小时，为“轻微”畸形；当未能显著恢复鼻子的基本特征时，为“严重”畸形。此时鼻子外观呈块状、无形状、错位且无标志。这些特征决定了切口部位、需要重新提升皮瓣的程度、软组织切除和软骨移植、分期的数量、是否使用辅助局部皮瓣、手术延迟以及是否需要进行第二次区域性皮瓣的再次手术。
通过新的直接切口和旧的周边边界瘢痕来进行修复。软组织切除和二次软骨移植可以有效地重建轮廓。通过从鼻孔边缘、鼻中隔、脸颊或上唇转移可利用的多余局部皮肤来解决衬里缺陷，以打开气道。如果局部组织不足，则必须转移第二个区域性皮瓣以覆盖或衬里鼻子。
