Andresen Julian Ramin, Scheufler Oliver
Medical School, Sigmund Freud University, Vienna, Austria.
Plastic and Aesthetic Surgery, AARE KLINIK, Bern, Switzerland.
Int J Surg Case Rep. 2021 Jun;83:105944. doi: 10.1016/j.ijscr.2021.105944. Epub 2021 Apr 30.
Reconstruction of the nasal tip is challenging, especially when large defects are associated with compromised nasal soft tissues and framework. The frontonasal flap is an axial-pattern myocutaneous flap from the glabella and nasal dorsum that allows for various modifications in flap design to cover medium sized defects of the nasal tip.
A 66-year-old male patient presented with a large and ulcerated squamous cell carcinoma of the nasal tip that was associated with substantial posttraumatic damage of the nasal soft tissue envelope and cartilaginous vault of the dorsum. Considering patient comorbidity, risk factors, and specific nasal condition, a single-stage tumor resection and reconstruction using a modified frontonasal flap was intended. While tumor excision resulting in a tip defect of 1.5 × 1.5 cm and flap coverage were initially achieved in a single stage, histologically incomplete tumor resection and individual patient requests mandated further surgery, including re-excision, cartilage grafting, and soft tissue contouring.
The frontonasal flap allows for single-stage reconstruction of moderate size tip defects. Even in the case of prior soft tissue damage and scarring, the flap may be used safely pending individual adjustments in flap design. However, additional measures may be employed as needed to optimize the functional and aesthetic outcome in cases of complex nasal pathology.
In a case with a combined tumor and posttraumatic nasal deformity, an individualized surgical concept incorporating a modified frontonasal flap with adjunct cartilage grafting and soft tissue contouring achieved an excellent functional and cosmetic outcome.
鼻尖重建具有挑战性，尤其是当大的缺损伴有鼻软组织和支架结构受损时。额鼻皮瓣是一种来自眉间和鼻背的轴型肌皮瓣，可对皮瓣设计进行多种改良，以覆盖鼻尖的中等大小缺损。
一名66岁男性患者，鼻尖部有一个巨大的溃疡性鳞状细胞癌，伴有鼻软组织包膜和鼻背软骨穹窿的严重创伤后损伤。考虑到患者的合并症、危险因素和特定的鼻部情况，打算采用改良额鼻皮瓣进行一期肿瘤切除和重建。虽然最初在一期完成了肿瘤切除，形成了一个1.5×1.5 cm的鼻尖缺损并进行了皮瓣覆盖，但组织学检查显示肿瘤切除不完全，且患者个人要求进一步手术，包括再次切除、软骨移植和软组织塑形。
额鼻皮瓣可用于一期重建中等大小的鼻尖缺损。即使在先前存在软组织损伤和瘢痕形成的情况下，在对皮瓣设计进行个体化调整之前，也可安全使用该皮瓣。然而，对于复杂的鼻部病变，可能需要根据需要采取额外措施，以优化功能和美学效果。
在一例合并肿瘤和创伤后鼻畸形的病例中，采用改良额鼻皮瓣并辅以软骨移植和软组织塑形的个体化手术方案，取得了优异的功能和美容效果。
