Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon.
Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Craniofac Surg. 2021;32(5):1864-1869. doi: 10.1097/SCS.0000000000007359.
Nasal defect coverage has some challenging aspects for plastic surgeons because of the midfacial location of the nose and the relationship between convexities and concavities of nasal subunits. The authors described our experience with performing keystone flap (KF) nasal reconstruction in accordance with the facial aesthetic subunit concept and demonstrated the expanding versatility of KFs in nasal reconstruction. Between January 2017 and February 2020, 15 patients (average age, 72.07 ± 13.00 years, range: 38-88 years) underwent KF reconstruction for nasal defects. We performed KF reconstruction in accordance with the facial aesthetic subunit concept. Data, including the defect causes and locations, defect sizes, flap sites and sizes, types of KFs, flap survival, complications, and follow-up period for each patient were reviewed retrospectively. Cosmetic outcomes were evaluated by independent plastic surgeons and patients through satisfactory postoperative surveys. Sixteen defects occurred in 15 patients. The defect sizes ranged from 0.8 × 1 cm to 2.5 × 3 cm. The flap sizes ranged from 1.5 × 3.5 cm to 4 × 6 cm. All defects were successfully covered with KFs from adjacent subunits. All flaps survived without any postoperative complications. At the mean follow-up period of 8.33 ± 2.92 months, the objective cosmetic outcomes were rated favorably, and the average subjective patient satisfaction score was 7.93 ± 1.28 on a scale of 1 to 10. We suggest that using KF reconstruction in consideration of the facial aesthetic subunit concept can be a promising alternative modality for covering nasal defects with outstanding aesthetic outcomes.
鼻缺损的覆盖对整形医生来说具有一些挑战性，因为鼻子位于中面部，且鼻亚单位的凸面和凹面之间存在关系。作者根据面部美学亚单位的概念描述了他们进行金本位制瓣（KF）鼻重建的经验，并展示了 KF 在鼻重建中的扩展应用的多功能性。2017 年 1 月至 2020 年 2 月，15 名患者（平均年龄为 72.07±13.00 岁，范围：38-88 岁）接受了 KF 重建鼻缺损。我们根据面部美学亚单位的概念进行了 KF 重建。回顾性分析了每位患者的数据，包括缺陷的原因和位置、缺陷的大小、皮瓣的部位和大小、KF 的类型、皮瓣的存活、并发症以及随访时间。通过独立的整形医生和患者进行术后满意度调查评估美容效果。15 名患者中有 16 个缺陷。缺陷大小从 0.8×1cm 到 2.5×3cm 不等。皮瓣大小从 1.5×3.5cm 到 4×6cm 不等。所有的缺陷都用相邻亚单位的 KF 成功覆盖。所有皮瓣均未出现术后并发症而存活。平均随访 8.33±2.92 个月后，客观美容效果评价良好，平均主观患者满意度评分为 7.93±1.28（1 至 10 分）。我们建议，在考虑面部美学亚单位概念的基础上，使用 KF 重建术可以成为一种很有前途的替代方法，可获得出色的美容效果。
