From the Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital.
Ann Plast Surg. 2022 Mar 1;88(1s Suppl 1):S106-S109. doi: 10.1097/SAP.0000000000003131.
Extensive nasal defects after resection of a malignancy are a challenge for all plastic surgeons. Nasal composite tissue defects have to be reconstructed with multiple staging surgeries. A paramedian pedicled forehead flap and free tissue transfer can be used for lining and skin replacement at different stages. In general, free tissue transfer is used for nasal lining and nasal floor reconstruction at the preliminary stage. Several weeks or months later, a paramedian pedicled forehead flap is used to replace the skin. Intermediate stages will also be necessary, and therefore the total therapeutic course is very long.
The aim of this study was to report the simultaneous use of a paramedian pedicle forehead flap and a free medial sural artery perforator (MSAP) flap to reconstruct a composite nasal defect after wide excision of squamous cell carcinoma.
In 2015, a 57-year-old woman with squamous cell carcinoma of the nose underwent tumor wide excision, which caused a composite defect involving multiple nasal subunits (partial tip, dorsum, right sidewall, right ala subunits). She received both a pedicled paramedian forehead flap to replace the skin and an MSAP flap to reconstruct the lining during the same procedure. At the intermediate stage 4 weeks later, the pedicled forehead flap was elevated and tailored. Then, a further 4 weeks later, flap division was performed.
The patient received a total of 3 surgical procedures to reconstruct the composite defects of multiple nasal subunits. Nasal reconstruction was done within 2 months. The patient was satisfied with the aesthetic appearance and functional outcome.
Simultaneous paramedian pedicle forehead and free flap reconstruction can provide an effective solution for composite nasal defects. Satisfactory functional and aesthetic results can be achieved.
恶性肿瘤切除后广泛的鼻缺损对所有整形外科医生来说都是一个挑战。鼻复合组织缺损需要通过多次分期手术来重建。正中带蒂额瓣和游离组织转移可在不同阶段用于衬里和皮肤替代。一般来说，游离组织转移用于初步阶段的鼻衬里和鼻底重建。几周或几个月后，使用正中带蒂额瓣来替换皮肤。还需要中间阶段，因此总治疗过程非常长。
本研究的目的是报告同时使用正中带蒂额瓣和游离内侧腓肠动脉穿支（MSAP）皮瓣来重建广泛切除鳞状细胞癌后复合鼻缺损。
2015 年，一名 57 岁女性患有鼻鳞状细胞癌，接受了肿瘤广泛切除术，导致多个鼻亚单位（部分鼻尖、鼻背、右侧壁、右侧鼻翼亚单位）的复合缺损。她在同一手术中接受了带蒂正中带蒂额瓣来替换皮肤和 MSAP 皮瓣来重建衬里。4 周后的中间阶段，抬起并修剪带蒂额瓣。然后，再过 4 周后，进行皮瓣分离。
患者共接受了 3 次手术来重建多个鼻亚单位的复合缺损。鼻重建在 2 个月内完成。患者对外观和功能结果均满意。
正中带蒂额瓣和游离皮瓣同时重建可提供复合鼻缺损的有效解决方案。可获得满意的功能和美学效果。
