Skin Cancer and Reconstructive Surgery Center (SCARS Center), Newport Beach, California, USA.
Facial Plast Surg Aesthet Med. 2020 Jul/Aug;22(4):294-300. doi: 10.1089/fpsam.2020.0066. Epub 2020 Apr 1.
Medium and large nasal defects are mostly addressed with paramedian forehead flap reconstruction. The superior extended nasal myocutaneous island (SENMI) flap offers an alternative that can be single stage and can avoid a gross deformity. To describe a new flap for nasal reconstruction of medium and large nasal defects and to define the flap's limitations and indications. This original study was a retrospective case series of patients who underwent SENMI flap reconstruction from 2008 to 2018 at a private tertiary referral center-Skin Cancer and Reconstructive Surgery Center (SCARS Center). Participants included all consecutive patients of the senior author who had undergone SENMI flap from September 2012 to December 2018, consisting of 53 patients. Indications for surgery were mostly skin cancer defects, postreconstructive, and post-traumatic deformities. IRB approval was obtained from the St. Joseph Health Center for Clinical Research. The location of the defects was defined. The vertical length of flap advancement was measured. Number of stages required to achieve functional and aesthetic goals was reported. Appearance rating after the first stage was assessed. A total of 53 patients [mean age 68 (range 30-92) years; 26 (49%) female and 27 (51%) male] were included in the case series. Reconstructed areas included 8 in the upper two-thirds of the nose (dorsum and sidewall), 34 in nasal tip, 32 in nasal ala, 12 in soft tissue triangle and infratip, and 13 full thickness defects of the alar rim. The flap advancing distance defined the nature of flap mobility. Of 53 patients, 41 had up to 2.0 cm of flap advancement and 12 had 2.0 to 3.2 cm of advancement. Of 52 patients aesthetically evaluated, 43 had mild or no detectable shape deformity on photographic evaluation after one stage. Single stage was performed in 25 patients, two stages in 21 patients, and three stages in 7 patients. Functional nasal valve stenosis was present in 18 patients (33%) after one stage. Partial flap ischemia occurred in two patients (4%). SENMI flap is an effective technique for nasal reconstruction. It offers a single- or two-stage alternative with less temporary deformity in comparison with forehead flap reconstruction.
中大型鼻缺损主要采用正中额瓣重建。 高级扩展鼻肌皮岛 (SENMI) 瓣提供了一种替代方法，可以是单阶段的，并且可以避免明显的畸形。 描述一种用于中大型鼻缺损鼻重建的新皮瓣，并确定皮瓣的局限性和适应证。 这是一项回顾性病例系列研究，于 2008 年至 2018 年在一家私人三级转诊中心-皮肤癌和重建外科中心 (SCARS 中心) 进行。参与者包括高级作者进行的 SENMI 皮瓣重建的所有连续患者，这些患者均来自 2012 年 9 月至 2018 年 12 月，共 53 例。手术适应证主要为皮肤癌缺损、重建后和创伤后畸形。圣约瑟夫健康中心临床研究伦理委员会批准了这项研究。 定义了缺损的位置。测量了皮瓣推进的垂直长度。报告了实现功能和美学目标所需的阶段数。评估了第一阶段后的外观评分。 共有 53 例患者[平均年龄 68 岁（范围 30-92 岁）；26 例（49%）女性和 27 例（51%）男性]被纳入病例系列研究。重建区域包括鼻背和侧墙的上三分之二 8 例、鼻尖 34 例、鼻翼 32 例、软组织三角和鼻翼下 12 例、鼻翼缘全厚缺损 13 例。皮瓣推进距离定义了皮瓣的活动性。在 53 例患者中，41 例皮瓣推进距离达 2.0cm，12 例皮瓣推进距离为 2.0 至 3.2cm。在 52 例经美学评估的患者中，43 例在第一阶段后经摄影评估有轻度或无法察觉的形状畸形。25 例患者行一期手术，21 例患者行二期手术，7 例患者行三期手术。一期术后有 18 例（33%）患者存在功能性鼻阀狭窄。2 例（4%）患者出现部分皮瓣缺血。 SENMI 皮瓣是一种有效的鼻重建技术。与额瓣重建相比，它提供了一种单阶段或两阶段的替代方法，暂时性畸形较小。
