Han Doo Hee, Mangoba Dennis Cristobal S, Lee Doh Young, Jin Hong Ryul
Department of Otorhinolaryngology, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, Korea.
Arch Facial Plast Surg. 2012 Sep-Oct;14(5):312-7. doi: 10.1001/archfacial.2012.520.
To present the aesthetic and functional outcomes of nasal alar reconstruction in Asian patients and to propose a working surgical algorithm.
Seventeen patients underwent nasal alar reconstruction at a university-based facial plastic surgery practice from March 1, 1998, through February 28, 2010. The male-female ratio was 10:7, with a median age of 59 years (range, 34-78 years), and the mean follow-up duration was 64 months.
The defect was mostly caused by basal cell carcinoma resection (14 of 17 [82%]), followed by the resection of squamous cell carcinoma, trauma, and excision of a previous scar. The mean defect size was 1.71 cm (range, 1-4 cm). The full-thickness defects were noted for 8 patients, whereas 9 had partial-thickness defects. The choice of reconstruction method was primarily based on the size and depth of the surgical defect. Most of the defects 1 to 2 cm in diameter needed nasolabial flaps (10 of 17 [59%]), whereas full-thickness defects larger than 2 cm needed forehead flaps (3 of 17 [18%]) to reconstruct the external defect. Smaller defects less than 1 cm were reconstructed with composite grafts (2 of 17 [12%]), a bilobed flap (1 of 17 [6%]), or primary closure (1 of 17 [6%]). Seven of 8 full-thickness defects had the internal nasal lining reconstructed using a septal mucoperichondrial flap, and 1 case was reconstructed using a cutaneous turn-in flap. Reinforcement cartilage graft was used in 8 patients. No flap failure occurred except in 1 case, in which necrosis of the internal lining flap caused contraction of the external flap with resultant alar rim elevation. An elevation of the alar margin and alar groove blunting occurred in 3 cases. No functional problems emerged. Subjective surgical outcome on a 4-point satisfaction scale revealed that 5 patients (29%) were much satisfied, 10 patients (59%) were satisfied, 1 patient (6%) was fairly satisfied, and 1 patient (6%) was dissatisfied.
The choice of reconstruction method of nasal alar defect in Asian patients depends primarily on the size and depth of the defect. Staged local flaps, use of cartilage reinforcement grafts, and internal lining reconstruction using septal mucoperichondrial flaps are key elements for achieving optimal aesthetic and functional results.
介绍亚洲患者鼻翼重建的美学和功能效果，并提出可行的手术方案。
1998年3月1日至2010年2月28日期间，17例患者在一所大学的面部整形手术科室接受了鼻翼重建手术。男女比例为10:7，中位年龄为59岁（范围34 - 78岁），平均随访时间为64个月。
缺损大多由基底细胞癌切除引起（17例中的14例[82%]），其次是鳞状细胞癌切除、外伤以及既往瘢痕切除。平均缺损大小为1.71 cm（范围1 - 4 cm）。8例为全层缺损，9例为部分厚度缺损。重建方法的选择主要基于手术缺损的大小和深度。大多数直径1至2 cm的缺损需要鼻唇瓣（17例中的10例[59%]），而直径大于2 cm的全层缺损需要额瓣（17例中的3例[18%]）来修复外部缺损。小于1 cm的较小缺损采用复合移植（17例中的2例[12%]）、双叶瓣（17例中的1例[6%]）或一期缝合（17例中的1例[6%]）进行重建。8例全层缺损中有7例使用鼻中隔黏骨膜瓣重建鼻内衬里，1例使用皮瓣翻转瓣重建。8例患者使用了加强软骨移植。除1例因内衬瓣坏死导致外部皮瓣收缩，进而引起鼻翼缘抬高外，未发生皮瓣失败。3例出现鼻翼缘抬高和鼻翼沟变钝。未出现功能问题。在4分制满意度量表上的主观手术结果显示，5例患者（29%）非常满意，10例患者（59%）满意，1例患者（6%）比较满意，1例患者（6%）不满意。
亚洲患者鼻翼缺损重建方法的选择主要取决于缺损的大小和深度。分期局部皮瓣、使用软骨加强移植以及采用鼻中隔黏骨膜瓣重建鼻内衬里是实现最佳美学和功能效果的关键要素。
