Abdurehim Yasin, Yasin Yalkun, K Tsang J X, Wu P A, Liang X N, Xukurhan Ayihen, Yong J, Alim Nilupar, Kuyax Pirdon, Mirzak Muzapper, Mutallip Muradil, Memet Abdukerimjan
Department of Otorhinolaryngology, Hongkong University Shenzhen Hospital, Shenzhen 518053, China Department of Otorhinolaryngology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
Department of Otorhinolaryngology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr 7;56(4):374-380. doi: 10.3760/cma.j.cn115330-20200319-00218.
To evaluate the application of three-staged paramendian forehead flap technique in reconstruction of severe full-thickness nasal defect. Clinical data of 7 cases with nasal reconstruction by three-staged forehead flap technique in the First Affiliated Hospital of Xinjiang Medical University and HongKong University Shenzhen Hospital between June 2016 and October 2019 was retrospectively reviewed. All were males aged from 10 to 71 years. There were 4 cases of basal cell carcinoma of the external nose, 2 cases of traumatic nasal defects and 1 case of large rhinophyma. All the operations were performed with the paramedian forehead flap in three stages. In stage Ⅰ, full layered forehead flap was transposed to the nasal detect. Lining flaps were reconstructed with folded forehead skin (=4), turn-over flap plus septal chondro mucosal pivotal flap (=2), or bipedicled vestibular skin and nasal mucosa advancement flap (=1). According to the reconstruction mode of the lining flaps, whether to implant cartilage to reconstruct the external nasal stent at stage Ⅰ was determined. At stage Ⅱ, the folded flaps were partly or completely separated from the covering flaps along the free edges of nasal alar. All the excess soft tissue including subcutaneous fat and frontalis muscle were excised, cartilage grafts were placed or sculpted to make an ideal nasal contour. The covering flaps were then returned on the recontoured, three-dimensional recipient bed. At stage Ⅲ, the pedicles were divided. Descriptive statistical method was used to analyze the data. In all cases, restoration of the nasal contour was remarkably good, no flap necrosis occurred. All patients were followed up for 6 months to 2 years, and the appearance and function of the nose recovered well. All patients were satisfied with their final aesthetic results. Three-staged paramedian forehead flap technique ensures maximal blood supply for the lining flap and the inserted cartilage graft, and restores an ideal three-dimensional nasal contour for reconstruction of large full thickness nasal defects.
评估正中旁前额皮瓣技术在严重全层鼻缺损修复中的应用。回顾性分析2016年6月至2019年10月在新疆医科大学第一附属医院和香港大学深圳医院采用三期前额皮瓣技术进行鼻再造的7例患者的临床资料。所有患者均为男性，年龄10至71岁。其中外鼻基底细胞癌4例，外伤性鼻缺损2例，巨大鼻赘1例。所有手术均采用正中旁前额皮瓣分三期进行。Ⅰ期，将全层前额皮瓣转移至鼻缺损处。采用折叠前额皮肤重建内衬皮瓣（4例）、翻转皮瓣加鼻中隔软骨黏膜枢轴皮瓣（2例）或双蒂前庭皮肤和鼻黏膜推进皮瓣（1例）。根据内衬皮瓣的重建方式，决定Ⅰ期是否植入软骨重建鼻外支架。Ⅱ期，沿鼻翼游离缘将折叠皮瓣与覆盖皮瓣部分或完全分离。切除所有多余的软组织，包括皮下脂肪和额肌，放置或雕刻软骨移植以形成理想的鼻轮廓。然后将覆盖皮瓣放回重塑后的三维受区创面。Ⅲ期，切断蒂部。采用描述性统计方法分析数据。所有病例鼻轮廓恢复良好，无皮瓣坏死发生。所有患者随访6个月至2年，鼻外观和功能恢复良好。所有患者对最终美学效果满意。三期正中旁前额皮瓣技术可确保内衬皮瓣和植入软骨移植获得最大血供，并为修复大型全层鼻缺损恢复理想的三维鼻轮廓。
