Wei Jiao, Herrler Tanja, Xu Hua, Li Qingfeng, Dai Chuanchang
From the *Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, Shanghai, China; and †Plastic and Reconstructive Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany.
Ann Plast Surg. 2017 Oct;79(4):359-364. doi: 10.1097/SAP.0000000000001160.
Patients with secondary unilateral cleft lip are regularly affected by serious nasal deformities especially of the alar and nasal floor. A large number of techniques for correction have been published, but symmetrical restoration of severe nasal deformation is difficult to achieve. We propose an innovative approach for anatomical restoration for this entity of nasal deformities to achieve long-term symmetrical appearance and muscular function.
A total of 68 patients with severe nasal deformity due to secondary unilateral cleft lip underwent reconstructive surgery using a double composite tissue Z-plasty technique for anatomical restoration of cartilage, muscle, and soft tissue layers. Patient pictures were taken preoperatively and postoperatively to evaluate appearance and incisional wound healing. The surgical outcome was assessed based on a postoperative patient satisfaction survey. All occurring adverse effects were recorded.
All patients were followed up for at least 7 months up to 8 years; mean follow-up period was 14.6 months. Patients were highly satisfied with the aesthetic result and improved facial profile (97.1%) and healing of the incision site (94.1%). There were 4 cases of implant deviation and 2 cases of impaired ventilation due to hypertrophic scarring of the upper lip (2 patients) and relatively decreased nostril size after augmentation rhinoplasty (1 patient), respectively, requiring surgical revision 1 year postoperatively. No other complications such as bleeding, infection, flap necrosis, and sensory dysfunction were recorded.
The double composite tissue Z-plasty technique allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleft lip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patient satisfaction and acceptance.
继发单侧唇裂患者常伴有严重的鼻畸形，尤其是鼻翼和鼻底畸形。虽然已经发表了大量的矫正技术，但严重鼻畸形的对称修复仍难以实现。我们提出一种创新方法，用于对这种鼻畸形进行解剖修复，以实现长期的对称外观和肌肉功能。
共有68例继发单侧唇裂导致严重鼻畸形的患者接受了重建手术，采用双复合组织Z成形术对软骨、肌肉和软组织层进行解剖修复。术前和术后拍摄患者照片，以评估外观和切口愈合情况。根据术后患者满意度调查评估手术效果。记录所有出现的不良反应。
所有患者随访至少7个月至8年；平均随访期为14.6个月。患者对美学效果、面部轮廓改善（97.1%）和切口部位愈合（94.1%）高度满意。分别有4例植入物移位和2例因上唇肥厚瘢痕（2例患者）导致通气障碍以及隆鼻术后鼻孔大小相对减小（1例患者），需要在术后1年进行手术修复。未记录其他并发症，如出血、感染、皮瓣坏死和感觉功能障碍。
双复合组织Z成形术可对单侧唇裂鼻畸形的软骨、肌肉和皮肤层进行彻底的解剖修复。这种单步方法是一种安全且技术上简单的治疗选择，患者满意度和接受度高。
