Austin Grace K, Shockley William W
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
Curr Opin Otolaryngol Head Neck Surg. 2016 Oct;24(5):453-60. doi: 10.1097/MOO.0000000000000295.
There are many well-established principles and surgical techniques for nasal reconstruction. The purpose of this study is to describe contemporary reconstruction of nasal defects. The unique anatomic features of the nose make this a challenging task. Although obtaining an optimal esthetic result is always the goal of reconstruction, maintenance and restoration of nasal function are of equal importance.
The first step of nasal reconstruction is a thoughtful analysis of the defect. The best surgical option will provide the patient with an excellent esthetic result and nasal function. Depending upon the extent of the defect as well as the anatomic site, a local flap, full-thickness skin graft, composite graft, or interpolated flap will provide the optimal result. The decision will depend on the surgeon's experience and expertise, as well as expectations and desires of the patient. Many cutaneous defects will require not only reconstruction of the defect, but also cartilage grafts to provide nasal contour and support. Most large or complex defects will require a paramedian forehead flap for reconstruction along with cartilaginous and/or bony support, as well as a lining flap.
This study highlights recent advances in nasal reconstruction and novel modifications of well-accepted traditional techniques.
鼻再造有许多成熟的原则和手术技术。本研究的目的是描述鼻缺损的现代再造方法。鼻子独特的解剖结构使其成为一项具有挑战性的任务。尽管获得最佳美学效果始终是再造的目标,但维持和恢复鼻功能同样重要。
鼻再造的第一步是对缺损进行深入分析。最佳手术方案应能为患者带来出色的美学效果和鼻功能。根据缺损范围及解剖部位,局部皮瓣、全厚皮片移植、复合移植或插入皮瓣可取得最佳效果。这一决定将取决于外科医生的经验和专业技能,以及患者的期望和诉求。许多皮肤缺损不仅需要修复缺损,还需要软骨移植以提供鼻轮廓和支撑。大多数大型或复杂缺损需要正中旁前额皮瓣进行再造,并辅以软骨和/或骨支撑以及衬里皮瓣。
本研究突出了鼻再造的最新进展以及对广为接受的传统技术的新颖改良。