Morera Serna Eduardo, Ferrán de la Cierva Luis, Fernández Meritxell Tomás, Canut Santiago Quer, Mesquida Jacoba Alba, Purriños Francisco José García
Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Islas Baleares, Spain.
Servicio de Otorrinolaringología, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1521-1525. doi: 10.1007/s00405-016-4380-z. Epub 2016 Nov 16.
Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.
鼻中隔穿孔的手术闭合是鼻科手术中最具挑战性的操作之一。由于难以调动足够的黏膜来闭合大的间隙以及在此过程中避免气道狭窄，大于2厘米的缺损采用传统方法修复尤为困难。我们介绍一种使用双侧哈达德 - 巴萨加斯特盖皮瓣在内镜下闭合鼻中隔大穿孔的新技术。我们机构对连续4例鼻中隔穿孔大于2厘米的患者进行了手术。在内镜下掀起双侧哈达德 - 巴萨加斯特盖皮瓣，其中一个在缺损上方，另一个在缺损下方，并旋转以部分覆盖两侧的缺损。将颞深筋膜深层移植物夹在两个皮瓣之间，为鼻黏膜生长提供支架。两个皮瓣均用硅胶片覆盖3周。4例患者中有3例实现了缺损的完全闭合；另一例实现了部分闭合。所有患者的鼻结痂、鼻出血和鼻通气均有改善。在选定的病例中，鼻中隔大缺损可通过旋转部分覆盖缺损区域的双侧带蒂鼻中隔黏膜皮瓣，随后鼻黏膜在作为上皮支架的自体移植物上二期愈合来闭合。
4级。
