Department of Otolaryngology - Head and Neck Surgery Mayo Clinic Arizona, Phoenix, AZ.
Georgetown University School of Medicine, Washington, DC.
J Craniofac Surg. 2021 May 1;32(3):1140-1142. doi: 10.1097/SCS.0000000000007161.
The use of diced cartilage grafting is a powerful tool during rhinoplasty for dorsal augmentation; however, its application to nasal structural reconstruction has rarely been reported. Here we present a unique technique for Mohs defect reconstruction combining diced cartilage graft for dorsal augmentation and a folded paramedian forehead flap for soft tissue. A 54-year-old female presented with recurrent basal cell carcinoma of the nose that had been previously resected 3 times in the past. This was treated with Mohs surgery resulting in a through and through nasal defect. This was reconstructed with a staged folded paramedian forehead flap with staged. Due to a loss of dorsal volume and definition creating an excess supratip break, a diced cartilage graft with fibrin glue and temporalis fascia was used for dorsal augmentation. The use of diced cartilage has regained popularity over the last 2 decades with multiple techniques utilizing diced cartilage alone, wrapped in fascia, covered in fascia, wrapped in oxidized methylcellulose, or solidified with fibrin glue. Literature describing the use of fibrin glue suggests that it improves wound healing by promoting cartilage growth, stabilization, and diffusion of nutrients to the graft. Its malleable nature allows for adjustments after the initial placement. This report demonstrates the viability of diced cartilage graft for dorsal augmentation with a paramedian forehead flap for nasal reconstruction. This technique can serve as a powerful tool for the nasal reconstructive surgeon needing scaffolding to rebuild and define the nasal dorsum.
使用软骨丁块移植是鼻整形术中进行鼻背增高的有力工具；然而，其在鼻结构性重建中的应用很少有报道。在这里，我们提出了一种独特的技术，将软骨丁块移植用于鼻背增高，并结合折叠正中额瓣用于软组织，用于Mohs 缺陷重建。一位 54 岁的女性因鼻基底细胞癌复发而就诊，该患者过去曾接受过 3 次手术切除。这例患者接受了 Mohs 手术治疗，导致贯穿性鼻缺损。采用分期折叠正中额瓣进行分期重建。由于背侧体积和形态丧失导致过度的鼻尖转折，使用纤维蛋白胶和颞筋膜的软骨丁块移植进行了背侧增高。在过去的 20 年中，软骨丁块的使用重新受到欢迎，多种技术单独使用软骨丁块，包裹在筋膜中、覆盖在筋膜上、包裹在氧化甲基纤维素中或用纤维蛋白胶固化。描述纤维蛋白胶使用的文献表明，它通过促进软骨生长、稳定和营养物质向移植物扩散来改善伤口愈合。其可塑性允许在初始放置后进行调整。本报告证明了软骨丁块移植联合正中额瓣用于鼻重建的鼻背增高的可行性。这种技术可以为需要支架重建和定义鼻背的鼻重建外科医生提供有力的工具。
