Gasteratos Konstantinos, Spyropoulou Georgia-Alexandra, Chaiyasate Kongkrit, Siotos Charalampos, Vlachopoulos Nikolaos, Friedstat Jonathan
From the Papageorgiou General Hospital of Thessaloniki, Plastic and Reconstructive Surgery Department, Thessaloniki, Greece.
Division of Plastic and Reconstructive Surgery, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Ann Plast Surg. 2022 Jun 1;88(6):679-686. doi: 10.1097/SAP.0000000000003032. Epub 2021 Dec 6.
Multiple microsurgical techniques for nasal reconstruction have been described in the literature. Given the gaps in the literature regarding evidence-based reviews for total and subtotal nasal reconstruction using microsurgical techniques, the purpose of this study was to provide a thorough presentation of the most popular microvascular techniques and their outcomes (functional and aesthetic) for total or subtotal nasal defects.
A systematic search was performed using PubMed, Google Scholar, and Cochrane Library on free flap techniques for restoration of nasectomy defects. The keywords were "nasal reconstruction," "nose," "nasectomy," "rhinectomy," and "microvascular." Inclusion criteria for analysis in the study were the largest clinical case series published in English within the past 15 years with more than 8 patients.Studies were analyzed for patient demographics, etiology of nasal loss, surgical approaches to reconstruction, outcomes, and complications. The current study was registered at the International Prospective Register of Systematic Reviews and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
The initial search yielded 302 results. Eleven articles with a total of 232 patients met the inclusion criteria. The radial (n = 85) and ulnar forearm flaps (n = 20), auricular helical rim (n = 87), and anterolateral thigh flap (n = 30) were the most commonly reported free flaps in nasal reconstruction. The main etiologic factors were malignancy and trauma. The most common complication was partial flap necrosis.
The auricular helical and radial forearm flaps represent the most used free flaps for total and/or subtotal nasal defects with satisfactory patient outcomes.
文献中已描述了多种用于鼻再造的显微外科技术。鉴于文献中缺乏关于使用显微外科技术进行全鼻和次全鼻再造的循证综述，本研究的目的是全面介绍最常用的微血管技术及其用于全鼻或次全鼻缺损的效果（功能和美学方面）。
使用PubMed、谷歌学术和Cochrane图书馆对用于修复鼻切除缺损的游离皮瓣技术进行系统检索。关键词为“鼻再造”“鼻子”“鼻切除”“鼻切除术”和“微血管”。本研究纳入分析的标准是过去15年内发表的英文最大临床病例系列，患者超过8例。对研究进行分析，内容包括患者人口统计学、鼻缺失病因、重建手术方法、效果及并发症。本研究已在国际前瞻性系统评价注册库注册，并根据系统评价和Meta分析的首选报告项目指南进行。
初步检索得到302条结果。11篇文章共232例患者符合纳入标准。桡侧（n = 85）和尺侧前臂皮瓣（n = 20）、耳廓螺旋缘皮瓣（n = 87）和股前外侧皮瓣（n = 30）是鼻再造中最常报道的游离皮瓣。主要病因是恶性肿瘤和创伤。最常见的并发症是部分皮瓣坏死。
耳廓螺旋皮瓣和桡侧前臂皮瓣是用于全鼻和/或次全鼻缺损最常用的游离皮瓣，患者效果满意。
