From St. Joseph's Hospital and the Palo Alto Medical Foundation/Sutter Health.
Plast Reconstr Surg. 2019 Jul;144(1):199-210. doi: 10.1097/PRS.0000000000005777.
Microvascular reconstruction of the nose was pioneered in China in the early 1970s using the radial forearm flap. Since then, different flaps, methods, and flap designs have been used to improve outcomes. Microvascular tissue transfer has become the first step of multistage reconstruction, which includes rebuilding the nasal framework, transferring a forehead flap for external skin coverage, and sculpting the nose for improved appearance and breathing. In this article, the authors present their long-term experience in microvascular reconstruction of the nose using the infolded radial forearm flap for full-thickness nasal defects, and a single circumferential flap for inner lining only.
Fifty microvascular nasal reconstruction procedures were performed on 47 patients between 2000 and 2017 using the radial forearm flap. The reconstructions included total/subtotal nasal defects using a trapezoid-shaped forearm flap folded in one or two planes, and a rectangular flap positioned internally and circumferentially for lining only. The nasal defects were caused by cancer resection, trauma, infection, cocaine abuse, and failed attempts at nasal reconstruction.
Forty-seven flaps were transferred successfully for nasal reconstruction, with two immediate failures (4 percent) caused by flap insetting complications and one late loss. Forty-six patients completed the multistage nasal reconstruction. Follow-up was 1 to 17 years (average, 6 years).
The radial forearm flap infolding technique is the authors' method of choice for microvascular reconstruction of the nose because it allows placement of a primary dorsal cartilage graft for optimal vascularization, and uses the excess dorsal skin during forehead resurfacing to modify the lining inset and shape the nostrils.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
20 世纪 70 年代初，中国率先开展了鼻显微血管重建，采用的是前臂桡侧皮瓣。此后，为了改善效果，不同的皮瓣、方法和皮瓣设计被用于鼻显微血管重建。显微血管组织转移已成为多阶段重建的第一步，包括重建鼻支架、额部皮瓣转移用于外部皮肤覆盖，以及雕刻鼻子以改善外观和呼吸功能。本文作者介绍了他们使用折叠前臂桡侧皮瓣治疗全层鼻缺损和单环形皮瓣仅用于内衬的长期经验。
2000 年至 2017 年间，作者对 47 例患者的 50 例鼻显微血管重建手术采用了前臂桡侧皮瓣。重建包括使用梯形折叠一到两层的前臂皮瓣和仅用于内衬的矩形皮瓣对内衬进行重建。鼻缺损是由癌症切除、创伤、感染、可卡因滥用和鼻重建失败引起的。
47 个皮瓣成功转移用于鼻重建，有两个立即失败（4%）是由于皮瓣插入并发症导致的，还有一个晚期皮瓣丢失。46 例患者完成了多阶段鼻重建。随访时间为 1 至 17 年（平均 6 年）。
前臂桡侧皮瓣折叠技术是作者进行鼻显微血管重建的首选方法，因为它允许放置一个主要的背侧软骨移植物以获得最佳的血管化，并在额部修复时利用多余的背侧皮肤来修改衬里插入并塑造鼻孔。
临床问题/证据水平：治疗性，IV。
