Lasso Jose M, La Cruz Esther Deleyto
Department of Plastic and Reconstructive Surgery, Hospital Gregorio Marañón, Universidad Complutense de Madrid.
Hospital Gregorio Marañón, Madrid, Spain.
J Craniofac Surg. 2018 Nov;29(8):2179-2181. doi: 10.1097/SCS.0000000000004807.
Wegener granulomatosis (WG) is a necrotizing vasculitis that involves the upper respiratory tract, the lungs, and the kidneys. It also causes deformities of the nose in practically all patients, altering the cartilaginous and bony structure as well as the inner lining of the nose.The surgical repair of these nasal distortions is a challenge mainly due to the impairment of wound healing and graft take that is caused both by the disease itself and by the prolonged immunosuppressant treatment.Many different reconstruction plans have been developed, using costal or calvarial bone grafts, cartilage grafts and local skin and mucosa flaps. Results have been diverse.The authors present the case of a 56-year-old patient who suffered from WG and consulted for nasal sequelae. She initially underwent several failed attempts at reconstruction; finally, the authors performed a nasal repair using a double strip of fascia lata as a dorsal graft, with no complications and a good aesthetic result.Fascia lata graft is a new and good option for nasal reconstruction in patients with WG because it is easily obtainable, it can be set in place through closed rhinoplasty and it can achieve good vascularization with low risk of resorption or disease reactivation.
韦格纳肉芽肿病（WG）是一种坏死性血管炎，累及上呼吸道、肺和肾脏。实际上，所有患者的鼻子都会出现畸形，改变鼻软骨和鼻骨结构以及鼻内衬里。这些鼻畸形的手术修复是一项挑战，主要是因为疾病本身和长期免疫抑制治疗会导致伤口愈合受损和移植物存活不良。人们已经制定了许多不同的重建方案，使用肋骨或颅骨骨移植、软骨移植以及局部皮肤和黏膜皮瓣。结果各不相同。作者介绍了一名56岁患有WG的患者因鼻后遗症前来咨询的病例。她最初进行了几次重建尝试均失败；最后，作者使用一条双层阔筋膜作为背侧移植物进行了鼻修复，未出现并发症，且美容效果良好。阔筋膜移植物是WG患者鼻重建的一种新的良好选择，因为它易于获取，可以通过闭合式鼻整形术放置到位，并且可以实现良好的血管化，吸收或疾病复发风险低。
