Santos Stahl Adelana, Gubisch Wolfgang, Fischer Helmut, Haack Sebastian, Meisner Christoph, Stahl Stéphane
From the *Department of Facial Plastic Surgery, Marienhospital Stuttgart, Stuttgart; †Department of Medical Biometry, and ‡Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Tübingen, Germany.
Ann Plast Surg. 2015 Dec;75(6):615-9. doi: 10.1097/SAP.0000000000000209.
In nasal reconstruction, the paramedian forehead flap is traditionally performed in 2 stages. To minimize the risk of flap necrosis, Millard described a 3-stage technique in a series of 5 cases in 1974. In this technique, an intermediate step of flap thinning is performed after flap transfer and before pedicle division. In this article, we compare the 2- and 3-stage techniques of paramedian forehead flaps for nasal reconstruction to determine the type and prevalence of complications related to each procedure.
Here, we present a retrospective review of a prospectively maintained database of paramedian forehead flaps for nasal reconstruction performed during a period of 6 years. We included all patients with 2- (n=87) and 3-stage (n=100) paramedian forehead flaps who had consistent and complete electronic patient records and followed them up for at least 6 months after pedicle division. We performed a regression analysis to adjust for the unequal distribution of complex cases.
Demographic factors and the causes for the nasal defects were similar in both groups. Although the nasal reconstructions were significantly more complex in the 3-stage group, the rate of partial forehead flap necrosis was similar in both groups (2-stage, 3.4%; 3-stage, 5%; P=0.601). A regression analysis showed that the relative risk of partial flap necrosis in complex cases did not differ significantly between groups (relative risk, 0.80; P=0.705).
To our knowledge, our study is the largest series published to date and the first one to compare the prevalence of forehead flap necrosis in the 2- versus the 3-stage technique for paramedian forehead flaps. We found no evidence that the use of a 3-stage forehead flap lowers the prevalence of necrosis. Until larger multicenter studies or meta-analyses can be conducted, smaller yet well-conducted studies such as the present one provide critical data and represent an important contribution to the field. Future research should investigate whether the 3-stage technique produces better aesthetic results than the 2-stage technique.
在鼻再造手术中，传统的正中旁前额皮瓣手术分两期进行。为将皮瓣坏死风险降至最低，1974年米勒德在一组5例患者中描述了一种三期技术。在该技术中，在皮瓣转移后、蒂部切断前进行皮瓣变薄的中间步骤。在本文中，我们比较正中旁前额皮瓣鼻再造的两期和三期技术，以确定与每种手术相关的并发症类型和发生率。
在此，我们对一个前瞻性维护的、关于6年间进行的正中旁前额皮瓣鼻再造数据库进行回顾性研究。我们纳入了所有接受两期（n = 87）和三期（n = 100）正中旁前额皮瓣手术且有一致且完整电子病历的患者，并在蒂部切断后对他们进行了至少6个月的随访。我们进行了回归分析以调整复杂病例分布不均的情况。
两组患者的人口统计学因素和鼻缺损原因相似。尽管三期组的鼻再造手术明显更复杂，但两组的部分前额皮瓣坏死率相似（两期组为3.4%；三期组为5%；P = 0.601）。回归分析显示，复杂病例中部分皮瓣坏死的相对风险在两组之间无显著差异（相对风险为0.80；P = 0.705）。
据我们所知，我们的研究是迄今为止发表的最大系列研究，也是第一项比较正中旁前额皮瓣两期与三期技术中前额皮瓣坏死发生率的研究。我们没有发现证据表明使用三期前额皮瓣可降低坏死发生率。在能够开展更大规模的多中心研究或荟萃分析之前，像本研究这样规模较小但开展良好的研究提供了关键数据，对该领域做出了重要贡献。未来的研究应调查三期技术是否比两期技术产生更好的美学效果。
