From the Section of Plastic Surgery, Virginia-Tech Carilion.
Plast Reconstr Surg. 2020 Dec;146(6):1371-1375. doi: 10.1097/PRS.0000000000007354.
Large nasal defects involving the tip, ala, and/or columella with denuded cartilage have traditionally required a two-stage forehead flap. As many Mohs patients are presenting older with increased medical comorbidities, a single-stage adipofascial turnover flap with a full-thickness skin graft was developed by the senior author as an alternative method. The authors hypothesize that the adipofascial turnover flap would have similar success rates and cost less than the forehead flap.
A retrospective review of all patients in the senior author's practice who underwent either a forehead flap or adipofascial turnover flap between January of 2016 and February of 2019 was conducted. The two groups were compared regarding success, complications, and cost.
There were seven forehead flap patients and 11 patients with adipofascial turnover flaps. Overall complications were three of seven (43 percent) for the forehead flap group and one of 11 (9 percent) for the adipofascial turnover flap group. There was one mortality, one revision for asymmetry, and one with airflow obstruction in the forehead group. The adipofascial turnover flap group had one partial skin graft loss that healed with local wound care only. There were no flap failures in either group, and the cost savings averaged over $22,000 in the adipofascial turnover flap group.
The single-stage adipofascial turnover flap with full-thickness skin grafting is a safe, reliable, and less expensive alternate to the forehead flap. The forehead flap will remain a workhorse in nasal reconstruction, but multiple operations increase cost and may contribute to higher complication rates. The adipofascial turnover flap appears to be an efficacious and reasonable option compared with the forehead flap.
涉及鼻尖、鼻翼和/或小柱且软骨裸露的大型鼻缺损传统上需要两期额部皮瓣。由于许多 Mohs 患者年龄较大，且合并症增多，因此高级作者开发了一种带全厚皮片的单期脂肪筋膜翻转皮瓣作为替代方法。作者假设脂肪筋膜翻转皮瓣的成功率与额部皮瓣相似，且成本更低。
对高级作者从 2016 年 1 月至 2019 年 2 月期间所行的所有额部皮瓣或脂肪筋膜翻转皮瓣患者进行了回顾性研究。比较了两组患者的成功率、并发症和费用。
额部皮瓣组有 7 例患者，脂肪筋膜翻转皮瓣组有 11 例患者。额部皮瓣组的总体并发症为 3 例（43%），脂肪筋膜翻转皮瓣组为 1 例（9%）。额部皮瓣组有 1 例死亡，1 例因不对称而需行修复术，1 例有气流阻塞。脂肪筋膜翻转皮瓣组有 1 例部分皮片丢失，仅通过局部伤口护理愈合。两组均无皮瓣失败，脂肪筋膜翻转皮瓣组的成本节省平均超过 22000 美元。
带全厚皮片的单期脂肪筋膜翻转皮瓣是一种安全、可靠且成本较低的额部皮瓣替代方法。额部皮瓣仍将是鼻重建的主力，但多次手术会增加成本，并可能导致更高的并发症发生率。与额部皮瓣相比，脂肪筋膜翻转皮瓣似乎是一种有效且合理的选择。
