From the Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School of Medical Science, Tokushima, Japan.
Ann Plast Surg. 2022 Feb 1;88(2):173-179. doi: 10.1097/SAP.0000000000002906.
Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities.
Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test.
Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients.
Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.
由于在平衡卓越的美学效果和减少手术创伤方面存在困难，因此鼻重建具有挑战性。已经有报道称使用外侧鼻动脉（LNA）穿支皮瓣进行鼻重建。但是，很少有报道描述了鼻重建的适当应用和鼻畸形的评估。本研究旨在量化使用该皮瓣的美学效果，并揭示与鼻畸形相关的危险因素。
20 名患者接受了 LNA 皮瓣与靠近鼻缺损的颅穿孔器的鼻重建。2 位独立的整形外科医生使用 5 分 Likert 量表对术后突出变形进行评分，并将其分为优秀、良好或差。使用单变量分析确定畸形的危险因素。开发了鼻翼偏斜指数来分析与皮瓣采集的相关性。感觉功能通过 Semmes-Weinstein 测试进行评估。
19 名患者（95％）的皮瓣存活，1 名患者的皮瓣远端坏死。所有使用的动脉穿孔器均位于颊部和鼻翼侧缘之间 5mm 以内。皮瓣最常用于覆盖 2 个亚单位，包括鼻侧壁缺损。6 名（30％）、8 名（40％）和 6 名（30％）患者的突出变形分别评为优秀、良好和差。涉及超过 3 个亚单位的鼻缺损导致严重的突出变形。仅在良好和中等组的 2 名患者（5％）中进行了额外的去瘤手术。比较手术前后的鼻翼偏斜指数后，鼻翼偏斜与皮瓣采集无显著相关性。所有患者均保留感觉功能。
使用 LNA 穿支皮瓣作为旋转弧度较大的推进瓣，可获得良好的美学效果和感觉功能。该皮瓣适用于不伴有任何严重鼻翼偏斜畸形的少于 2 个鼻亚单位的鼻重建。此外，由于需要较少的侵入性 1 期手术，因此该皮瓣可获得更好的效果。
