Department of Dermatology, University of Minnesota, 516 Delaware St. SE, Mail Code 98, Philips-Wangensteen Building, Suite 4-420, Minneapolis, MN, 55455, USA.
Department of Dermatology, Saint Louis University School of Medicine, 1755 S. Grand Blvd, Room 210, St. Louis, MO, 63104, USA.
Arch Dermatol Res. 2020 Oct;312(8):575-579. doi: 10.1007/s00403-020-02039-4. Epub 2020 Feb 14.
Few studies exist that compare local flap repair designs either mathematically or clinically. Previous mathematical studies use a two-dimensional modeling approach, which is not suited to complex structures like the nose. To quantitatively analyze and compare flap designs for nasal repair using three-dimensional, photographic models. via a three-dimensional imaging system (Vectra M3, Canfield Scientific, Parsippany, NJ, USA), images were captured of actual post-Mohs nasal defects on 12 consecutive patients. Transposition, rotation, and advancement flap designs were designed and assessed based on tissue efficiency (E = SA/(SA + SA) × 100), suture efficiency (E = SA/Length× 100), total area undermined, combined 1° and 2° flap motion efficiency (E = SA/(SA- (SA + SA)) × 100), incision efficiency (E = SA/length× 100), and undermining efficiency (E = SA/SA× 100). Rotation flap designs are the most tissue efficient (p < 0.001). Transposition designs are the least suture efficient (p = 0.012) and require less undermining than the corresponding rotation flaps (although not statistically significant). Advancement flaps have the highest flap motion efficiency (p = 0.027). Incision and undermining efficiency is equivalent between all three designs (p = 0.308 and p = 0.158, respectively). While statistically significant differences exist between the flaps studied, the clinical significance is unknown. Consequently, the choice in repair design should be made based on its ability to attain a functionally and aesthetically successful reconstruction.
鲜有研究对局部皮瓣修复设计进行数学或临床比较。先前的数学研究采用二维建模方法，这不适用于像鼻子这样的复杂结构。本研究旨在通过三维摄影模型，使用三维成像系统（Vectra M3，Canfield Scientific，Parsippany，NJ，USA），对鼻修复用皮瓣设计进行定量分析和比较。从 12 例连续患者中获取实际的 Mohs 术后鼻部缺损的图像。基于组织效率（E=SA/（SA+SA）×100）、缝线效率（E=SA/Length×100）、总去瓣面积、1°和 2°皮瓣总运动效率（E=SA/（SA-（SA+SA））×100）、切口效率（E=SA/Length×100）和去瓣效率（E=SA/SA×100），设计皮瓣的转位、旋转和推进设计。旋转皮瓣设计的组织效率最高（p<0.001）。皮瓣的转位设计缝线效率最低（p=0.012），且比相应的旋转皮瓣所需的去瓣面积更小（尽管无统计学意义）。推进皮瓣的皮瓣运动效率最高（p=0.027）。所有三种设计的切口和去瓣效率相当（p=0.308 和 p=0.158）。虽然所研究的皮瓣之间存在统计学差异，但临床意义未知。因此，修复设计的选择应基于其实现功能和美学成功重建的能力。
