Department of Dermatology, University of California, Irvine, Irvine, California.
Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
Dermatol Surg. 2021 Jan 1;47(1):86-93. doi: 10.1097/DSS.0000000000002714.
Surgical defects of the distal nose can pose significant reconstructive challenges. Free cartilage batten graft (FCBG) with secondary intention healing is an underreported yet effective repair option with cosmetically and functionally satisfying outcomes.
To share the authors' experience using FCBG with secondary intention healing on multiple nasal subunits, including a detailed evaluation of wound/graft characteristics and design modifications to optimize success with this single-stage approach.
A retrospective study of 129 patients who underwent FCBG with secondary intention healing after Mohs surgery from 2011 to 2018, using statistical analysis of numerous outcome measures graded independently by 2 fellowship-trained Mohs surgeons.
Overall, healed wounds were graded aesthetically as follows: excellent (24%), very good (31%), good (31%), or poor (14%). Excellent/very good outcomes were seen for superficial (p < .001), small-to-medium sized wounds (p < .0001) repaired with cartilage that closely approximated the defect size (p < .05). Consistently optimal outcomes were seen in the 19 repairs involving the alar lobule (mid-ala) alone, graded excellent (47%), very good (32%), and good (21%). A majority of patients (86%) experienced mild to no alar retraction. Although 67% of all patients had some skin surface contour irregularity, only 8% of patients sought dermabrasion. Neither hematoma, infection, ear deformity, chondritis, nor graft desiccation were reported.
A modified approach to FCBG with secondary intention healing provides a reliable, minimalistic, low-risk reconstructive option for mid-alar defects.
鼻尖部的手术缺损会带来重大的重建挑战。游离软骨条（FCBG）二期愈合是一种报道较少但有效的修复选择，可获得美容和功能满意的效果。
分享作者使用游离软骨条二期愈合修复多个鼻尖亚单位的经验，包括详细评估伤口/移植物的特征，并对设计进行修改，以优化这种单阶段方法的成功率。
对 2011 年至 2018 年期间因 Mohs 手术而行 FCBG 二期愈合的 129 例患者进行回顾性研究，由 2 位接受过 Mohs 手术 fellowship培训的医师独立对多项结局指标进行评分，并进行统计学分析。
总体而言，愈合的伤口在美学上被评为：优秀（24%）、非常好（31%）、良好（31%）或差（14%）。对于浅层（p<0.001）、小至中型（p<0.0001）、与缺损大小相近的软骨（p<0.05）修复的伤口，观察到优秀/非常好的结果。单独修复鼻翼（中鼻翼）的 19 例修复中，始终观察到最佳结果，评为优秀（47%）、非常好（32%）和良好（21%）。大多数患者（86%）仅经历轻度至无鼻翼回缩。尽管所有患者中有 67%存在一定程度的皮肤表面轮廓不规则，但只有 8%的患者寻求皮肤磨削术。未报告血肿、感染、耳畸形、软骨炎或移植物干燥。
游离软骨条二期愈合的改良方法为中鼻翼缺损提供了一种可靠、简约、低风险的重建选择。
