Section of Plastic Surgery, Cagliari University Hospital, Cagliari, Italy.
Eur Rev Med Pharmacol Sci. 2012 Nov;16(13):1866-72.
In nasal reconstruction all anatomic layers as cover, lining, and support, have to be replaced to restore proper aesthetics. Forehead skin has been acknowledged as the best donor site to resurface the nose. Traditionally forehead flap reconstruction is performed in two stages, but Millard described an intermediate third stage between flap transfer and pedicle division. This study compared the two methods.
The study enrolled 31 patients undergoing total or subtotal nose reconstruction between January 2001 and January 2012. 20 patients underwent to the two-step technique (2S Group), and 11 the three-step technique (3S Group). Thickness of the flap was measured in three different areas. A plastic surgeon not involved in the study completed an evaluation questionnaire to assess aesthetic satisfaction (VAS = 1-10).
The total number of procedures performed (including revisions) ranged from 3 to 6. The average number of procedures performed in group 2S patients was 4 (range: 3-6) in the group 3S was 3.46 (range: 3-5). VAS mean values were studied with t Student test and were found to be significant.
The timing of thinning of the flap and detachment of the pedicle varies among Authors. There are generally two trends: defatting of the flap before the pedicle transection, performed usually 3 weeks from flap harvesting and defatting a few months after disconnection of the pedicle. We think this technique is suited for defects including underlying structures and particularly for all those defects located in the distal part of the nose (tip and nostrils).
在鼻重建中，所有的解剖层次，包括覆盖层、衬里层和支撑层，都必须被替换，以恢复适当的美学效果。额部皮肤被认为是修复鼻子表面的最佳供区。传统的额瓣重建分两期进行，但 Millard 描述了瓣转移和蒂部分离之间的中间第三期。本研究比较了这两种方法。
本研究纳入了 2001 年 1 月至 2012 年 1 月期间接受全鼻或部分鼻重建的 31 例患者。20 例患者接受了两步技术（2S 组），11 例患者接受了三步技术（3S 组）。测量了三个不同区域的瓣厚度。一位不参与研究的整形医生完成了评估问卷，以评估美学满意度（VAS=1-10）。
所进行的手术总数（包括修正术）范围为 3 至 6 次。2S 组患者的平均手术次数为 4 次（范围：3-6 次），3S 组为 3.46 次（范围：3-5 次）。用 t 检验对 VAS 均值进行了研究，发现有显著差异。
瓣的变薄和蒂的分离时间因作者而异。通常有两种趋势：在蒂部切断前对瓣进行去脂，通常在瓣采集后 3 周进行，在蒂部断开后几个月进行去脂。我们认为这种技术适用于包括基底结构在内的缺损，特别是位于鼻子远端（鼻尖和鼻孔）的所有缺损。
