John Jithin, Gupta Rohun, Grossbauer Anne, Chung Michael, Sethna Anita, Abboud Michel, Cox Eric, Hart Justin, Folbe Adam, Chaiyasate Kongkrit
School of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Department of Otolaryngology, Wayne State University, Detroit, Michigan.
Arch Plast Surg. 2022 Apr 6;49(2):184-194. doi: 10.1055/s-0042-1744426. eCollection 2022 Mar.
The face and the external nose define an individual's physical appearance. Nasal deformities can cause facial disfigurement along with unwanted psychological repercussions. Nasal deformities range in severity, with the most severe cases being indications for a rhinectomy, due to the complexity of the nasal defect. According to published literature, there is no consensus among otolaryngologists and plastic surgeons on which technique or flap use is preferred in terms of complications, aesthetic outcome, or patient satisfaction. The goal of this study is to provide a comprehensive analysis of published studies on nasal reconstruction following rhinectomy. Using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for writing systematic reviews, a systematic review was conducted. Four databases were searched using a search strategy. These articles were then imported into the COVIDENCE software and went screening and thorough article review. After screening 2,237 articles, 23 studies were then extracted for data collection analysis. We collected data from 12 case series, 4 case studies, 1 prospective case series, and 4 retrospective chart review studies. The most commonly reported flaps were forehead flaps, superior extended nasal myocutaneous island, forearm free flaps, anterolateral thigh (ALT) free flap, medial femoral condyle free flap ( = 8), and zygomaticus implants ( = 6), and retained nasal prosthesis. Although not specifically indicated by a certain number, the most common indication for the rhinectomy was malignancy, followed by traumas, postsurgical complications, radionecrosis, and congenital nasal malformations. Although several donor flaps can be used after rhinectomy, we conclude that there is no preference over what flap has superior patient outcomes after analysis. As of current, there are no prospective studies that exist. Therefore, more research is necessary to determine the results of each flap.
面部和外鼻决定了一个人的外貌。鼻畸形会导致面部毁容，并带来不良的心理影响。鼻畸形的严重程度各不相同，最严重的病例因鼻缺损的复杂性而需要进行鼻切除术。根据已发表的文献，在并发症、美学效果或患者满意度方面，耳鼻喉科医生和整形外科医生对于哪种技术或皮瓣的使用更优尚未达成共识。本研究的目的是对已发表的鼻切除术后鼻重建研究进行全面分析。按照系统评价和Meta分析方案的首选报告项目指南来撰写系统评价，进行了一项系统评价。使用搜索策略对四个数据库进行了检索。然后将这些文章导入COVIDENCE软件进行筛选和全面的文章评审。在筛选了2237篇文章后，提取了23项研究进行数据收集分析。我们从12个病例系列、4个病例报告、1个前瞻性病例系列和4个回顾性图表审查研究中收集了数据。最常报道的皮瓣是额部皮瓣、鼻上延伸肌皮岛状瓣、前臂游离皮瓣、股前外侧（ALT）游离皮瓣、股骨内侧髁游离皮瓣（n = 8）和颧植入物（n = 6），以及保留鼻假体。虽然没有具体数字表明，但鼻切除术最常见的适应证是恶性肿瘤，其次是创伤、术后并发症、放射性坏死和先天性鼻畸形。虽然鼻切除术后可以使用几种供区皮瓣，但我们得出结论，经分析后对于哪种皮瓣能带来更优的患者预后并无偏好。截至目前，尚无前瞻性研究。因此，需要更多研究来确定每种皮瓣的效果。
