Iyer Hari, Bussière Nicholas, Salib George Emmanuel
Division of Plastic & Reconstructive Surgery, Université de Montréal, Montreal, QC, Canada.
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Plast Reconstr Surg Glob Open. 2021 Apr 8;9(4):e3526. doi: 10.1097/GOX.0000000000003526. eCollection 2021 Apr.
The nose is a common site for cutaneous malignancy and post-ablative reconstruction. To our knowledge, a myocutaneous island flap based on the levator labii superioris alaeque nasi (LLSAN) and nasalis muscles, with vascularity from the lateral nasal and angular arteries, has not been described for reconstruction of the lower lateral nose.
A retrospective chart review of patients who underwent LLSAN-nasalis island flap reconstruction between 2015 and 2019 was performed. The surgical technique involved marking of an inverted-V flap on the nasal sidewall. The skin lateral to the flap was then developed in the subcutaneous plane to expose the LLSAN muscle and divide its origin on the maxillary frontal process and its caudal insertions into the alar dermis. The medial incision was down to periosteum and perichondrium, and dissection beneath the flap separated it from the nasal support structure. The resultant flap had a great caudal mobility. The donor site was closed in a V-to-Y pattern.
84 procedures were completed, mostly for alar defects (57.1%) between 100 and 400 mm (71.4%). The average age of patients was 74.9 years. An estimated 27 patients were lost to follow-up. At mean follow-up of 24.3 weeks, there were no cases of flap necrosis, 1 case of hematoma (1.8%), 1 case of infection (1.8%), 3 cases of persistent trapdoor deformity (5.3%), and 3 cases of alar notching (5.3%), 1 of whom required revision surgery.
The LLSAN-nasalis myocutaneous island flap is a simple, reliable technique for resurfacing lateral lower nasal defects up to 2 × 2 cm.
鼻子是皮肤恶性肿瘤和消融后重建的常见部位。据我们所知，尚未有基于提上唇鼻翼肌（LLSAN）和鼻肌的肌皮岛状皮瓣用于鼻外侧下部重建的相关描述，该皮瓣的血供来自鼻外侧动脉和内眦动脉。
对2015年至2019年间接受LLSAN - 鼻肌岛状皮瓣重建的患者进行回顾性病历审查。手术技术包括在鼻侧壁标记一个倒V形皮瓣。然后在皮下平面掀起皮瓣外侧的皮肤，以暴露LLSAN肌，并将其在上颌额突的起点及其向尾侧插入鼻翼真皮的部分分开。内侧切口直至骨膜和软骨膜，皮瓣下方的分离将其与鼻支撑结构分开。所得皮瓣具有很大的向尾侧的活动度。供区采用V - Y缝合关闭。
共完成84例手术，主要用于修复100至400毫米（71.4%）的鼻翼缺损（57.1%）。患者的平均年龄为74.9岁。估计有27例患者失访。平均随访24.3周时，未出现皮瓣坏死病例，1例血肿（1.8%），1例感染（1.8%），3例持续性活板门畸形（5.3%），3例鼻翼切迹（5.3%），其中1例需要进行修复手术。
LLSAN - 鼻肌肌皮岛状皮瓣是一种简单、可靠的技术，可用于修复最大达2×2厘米的鼻外侧下部缺损。
