Sinha Mohit, Hirani Narendra, Khilnani Ajeet Kumar
Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP India.
Gujarat Adani Institute of Medical Sciences, GK General Hospital, Bhuj, Kachchh, Gujarat 370001 India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):1701-1705. doi: 10.1007/s12070-021-02835-y. Epub 2021 Sep 4.
Interpolated flaps remain the mainstay of nasal reconstruction. In this regard Paramedian forehead flap has been combined and modified variously by different surgeons. However, still multiple stages are required to give shape to the nose and ensure that skin and cartilaginous vault of nose are aesthetically and functionally reconstructed. However, we describe a technique in which cartilage is reconstructed at the same stage as harvesting the flap without risk of vascular compromise.
We describe a retrospective chart review of reconstructive nasal procedure in 2 stages with reconstruction in the first sitting itself using Paramedian forehead flap and ipsilateral septal perichrondium and septal cartilage in 4 patients of lower nasal vault deficiency between Jan 2018 to Dec 2018. The patients age ranged from 10 to 67 Years. 2 of the patients needed surgery due to dog bite injury 1 due to excision of basal cell carcinoma and another due to road traffic accident. The technique involved harvesting an ipsilateral paramedian forehead flap along with ipsilateral septal perichondrial flap anteriorly based and using septal cartilage to make the skeleton. The flap was divided after 3 weeks and thinned suitably.
All the patients reported complete uptake of flap without any cartilage necrosis. Functionally none of the patient reported more nasal block than that seen preoperatively. The average NOSE VAS score remained 17.5 reported 1 month after the second stage.
Planning is the key for appropriate and cosmetically feasible nasal con-struction. Emphasis must be given to nasal subunit being reconstructed and the choice of flap must be robust. Our forehead flap uses 2 stage design with septal flap to allow for cartilage reconstruction in situ. We utilized post op small vessel dilators along with BACTIGRAS dressings to prevent infection. Our technique in both cases allowed for a greater nasal airway and greater nasal valve suppor.t.
插入式皮瓣仍然是鼻再造的主要方法。在这方面，不同的外科医生对正中旁前额皮瓣进行了多种组合和改良。然而，仍然需要多个阶段来塑造鼻子的形状，并确保鼻的皮肤和软骨穹窿在美学和功能上得到重建。然而，我们描述了一种技术，即在切取皮瓣的同一阶段进行软骨重建，而不存在血管受损的风险。
我们对2018年1月至2018年12月期间4例鼻下穹窿缺损患者进行的两阶段鼻再造手术进行了回顾性图表分析，第一阶段使用正中旁前额皮瓣和同侧鼻中隔软骨膜及鼻中隔软骨进行再造。患者年龄在10至67岁之间。其中2例患者因犬咬伤需要手术，1例因基底细胞癌切除，另1例因道路交通事故。该技术包括切取同侧正中旁前额皮瓣以及基于前方的同侧鼻中隔软骨膜瓣，并使用鼻中隔软骨制作支架。3周后将皮瓣分开并适当变薄。
所有患者均报告皮瓣完全成活，无软骨坏死。在功能方面，没有患者报告鼻塞比术前更严重。第二阶段术后1个月报告的平均鼻VAS评分为17.5分。
规划是进行合适且美观可行鼻再造的关键。必须重视要重建的鼻亚单位，皮瓣的选择必须可靠。我们的前额皮瓣采用两阶段设计并结合鼻中隔瓣，以便原位进行软骨重建。我们在术后使用了小血管扩张剂以及BACTIGRAS敷料来预防感染。我们的技术在两种情况下都能提供更大的鼻气道和更强的鼻瓣支撑。
