外侧扩展鼻岛状皮瓣在鼻重建中的应用。
Use of a Lateral Extended Nasal Island Flap for Nasal Reconstruction.
机构信息
Skin Cancer and Reconstructive Surgery Center, Newport Beach, California.
出版信息
JAMA Facial Plast Surg. 2019 Sep 1;21(5):434-439. doi: 10.1001/jamafacial.2019.0423.
IMPORTANCE
Small and medium nasal defects of the nose have been treated mostly with local skin flaps and skin grafts producing variable aesthetic outcomes. The lateral extended nasal island (LENI) myocutaneous flap provides a reliable single-stage reconstruction for small to medium nasal defects, including those in the nasal tip, with excellent cosmetic results.
OBJECTIVE
To describe and define a new version of the lateral nasal island flap for small to medium nasal defects.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series included all patients who had undergone reconstruction with the lateral nasal island flaps and LENI flaps from October 2009 to July 2018 with 97 consecutive cases studied. Indications for surgery were mostly skin cancer defects. The analysis was performed from January 1, 2018, through December 15, 2018.
MAIN OUTCOMES AND MEASURES
The location and the size of the defects were defined. Number of stages required to achieve functional and aesthetic goals was reported. Appearance rating after the first stage was assessed.
RESULTS
The case series included 82 patients (mean age, 64 years [range, 31-90 years]; 36 [43%] women and 46 [57%] men). These 82 patients' flaps qualified as the LENI flap. Of these, 54 (65%) were used for nasal tip reconstruction. The flap advancing distance ranged from 0.7 cm to 1.8 cm (mean advancing distance, 1.2 cm). Of 67 patients with available postoperative photographic documentation, 44 had mild or undetectable signs of reconstruction, 21 had visible scars, and 3 had obvious deformities. A single-stage procedure was performed in 66 cases, 2 stages in 15 cases, and 3 stages in 2 cases.
CONCLUSIONS AND RELEVANCE
The LENI myocutaneous flap is a reliable technique for reconstruction of nasal defects up to 1.8 cm. The extended dissection and release of the flap at piriform aperture achieves the predictable outcome and separates it from the previously described lateral nasal island flaps.
LEVEL OF EVIDENCE
重要性
小和中等鼻缺陷的鼻子已被大多用局部皮瓣和皮片治疗，产生不同的美容结果。外侧扩展鼻岛（LENI）肌皮瓣为小至中等鼻缺陷提供了可靠的单一阶段重建，包括鼻尖，具有极好的美容效果。
目的
描述和定义一种新的小到中等鼻缺陷的外侧鼻岛皮瓣。
设计、设置和参与者：这项回顾性病例系列包括所有 2009 年 10 月至 2018 年 7 月期间接受外侧鼻岛皮瓣和 LENI 皮瓣重建的患者，共 97 例连续病例进行了研究。手术指征主要为皮肤癌缺损。分析于 2018 年 1 月 1 日至 2018 年 12 月 15 日进行。
主要结果和措施
定义了缺陷的位置和大小。报告了实现功能和美容目标所需的阶段数。评估第一阶段后的外观评分。
结果
该病例系列包括 82 例患者（平均年龄 64 岁[范围 31-90 岁]；36 例[43%]为女性，46 例[57%]为男性）。这些 82 例患者的皮瓣为 LENI 皮瓣。其中 54 例（65%）用于鼻尖重建。皮瓣推进距离为 0.7 厘米至 1.8 厘米（平均推进距离为 1.2 厘米）。在 67 例有术后摄影记录的患者中，44 例有轻度或无法察觉的重建迹象，21 例有可见的疤痕，3 例有明显的畸形。66 例患者行单阶段手术，15 例患者行 2 阶段手术，2 例患者行 3 阶段手术。
结论和相关性
LENI 肌皮瓣是一种可靠的技术，用于重建 1.8 厘米以内的鼻缺损。梨状孔处的皮瓣扩展解剖和松解可达到可预测的结果，并将其与以前描述的外侧鼻岛皮瓣区分开来。
证据水平
4 级。
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