Duong Chien M, Ngo Duy Q, Tran Toan D, Ngo Quy X, Le Quang V
Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam; Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, Viet Nam.
Vietnam National Cancer Hospital, 30 Cau Buou Street, Thanh Tri District, Hanoi, Viet Nam.
Int J Surg Case Rep. 2019;58:127-131. doi: 10.1016/j.ijscr.2019.04.033. Epub 2019 Apr 22.
Nasal-type extranodal natural killer (NK)/T-cell lymphomas are a rare type of clinical condition. Reconstruction of the complex nasal defect after chemoradiation is extremely challenging for plastic surgeons.
Here we present the case of a 56-year old female with the condition of a nasal-type NK/T-cell lymphoma which had caused complex nasal disfigurement. The patient had undergone chemoradiotherapy. Lesions after treatment were present all over the nasal defect (nasal septum, mucosa, support frame and skin) and the left cheek medial subunit. The surgery was subdivided into 3 stages. First, we removed the infectious tissue and restored the wall of nasal cavity by the left forehead - scalp flap. Second, we used the pedicle of the left forehead flap to rebuild the nasal mucosa defect, the rotational flap to rebuild the cheek defect, and the right forehead flap to recovered skin defect of the nose. Finally, we divided the pedicle of right forehead flap.
The complex nasal defect is difficult to reconstruct and has a higher risk of failure in patient who received chemoradiotherapy. It is crucial to choose the right materials and have a confident plan in order to achieve successful results for the sake of the patient.
Our case report shows that the nasal defect caused by a nasal-type NK/T-cell lymphoma is complex. After our 3 stages plan for the surgery, as well as using multiple flaps for reconstruction from the forehead skin, the result was significant reduction in the disfiguration of the patient's nose.
鼻型结外自然杀伤（NK）/T细胞淋巴瘤是一种罕见的临床病症。对于整形外科医生而言，放化疗后复杂鼻缺损的修复极具挑战性。
在此，我们报告一例56岁女性鼻型NK/T细胞淋巴瘤患者，该疾病导致了复杂的鼻面部畸形。患者接受了放化疗。治疗后的病变累及整个鼻缺损区域（鼻中隔、黏膜、支撑框架和皮肤）以及左侧面颊内侧亚单位。手术分为三个阶段。首先，我们切除感染组织，并用左前额 - 头皮瓣修复鼻腔壁。其次，我们利用左前额瓣蒂重建鼻黏膜缺损，利用旋转瓣重建面颊缺损，利用右前额瓣修复鼻皮肤缺损。最后，我们切断右前额瓣的蒂部。
复杂鼻缺损修复困难，接受放化疗的患者失败风险更高。为了患者获得成功的治疗效果，选择合适的材料并制定可靠的方案至关重要。
我们的病例报告表明，鼻型NK/T细胞淋巴瘤导致的鼻缺损很复杂。经过我们的三阶段手术方案，以及使用多个前额皮瓣进行重建后，患者鼻部的畸形得到了显著改善。
