Andresen Julian Ramin, Scheufler Oliver
Klinik für Orthopädische-, Unfall-, und Wiederherstellungschirurgie, Charite Universitätsmedizin Berlin - Campus Benjamin Franklin, Berlin, Germany.
Plastische und Ästhetische Chirurgie, AARE KLINIK, Bern, Switzerland.
Handchir Mikrochir Plast Chir. 2023 Aug;55(4):278-286. doi: 10.1055/a-2069-2246. Epub 2023 May 24.
This study investigates the results of nasal tip reconstruction with the frontonasal flap compared with other locoregional flaps.
All nasal tip reconstructions with locoregional flaps performed during a 10-year period were included. Defect size, flap type, risk factors, comorbidities, complications, revisions, and secondary operations were retrospectively assessed. Clinical follow-up examinations were performed after 12 months. Digital photographs were taken in standard projections preoperatively and at the time of the last follow-up examination, and the aesthetic results were assessed by three independent examiners, with nasal contour, symmetry, scarring, and match of skin colour between flap and nasal skin rated on a 4-point scale. Finally, patient satisfaction was obtained.
A total of 112 nasal tip reconstructions were performed in 68 women and 44 men with a mean age of 71,4±10,2 years. Taking into account defect size, individual factors and patient preference, reconstruction was performed with 58 frontonasal flaps, 23 Rintala flaps, 20 paramedian forehead flaps and 11 bilobed flaps. Mean age and comorbidities of patients were comparable between flap types, except for a higher incidence of arterial hypertension and a lower incidence of diabetes mellitus in patients treated with frontonasal flaps. Defect size was the same in reconstructions with frontonasal flaps and Rintala flaps, smaller in bilobed flaps, and more extensive in paramedian forehead flaps. There were no differences in complication rates between the different flap techniques. Taking into account the planned second interventions (flap pedicle separations) in the paramedian forehead flaps, the frequency of unplanned corrections was comparable for all flap techniques. Aesthetic results and patient satisfaction were rated as very good or good in more than 90% with all techniques.
Compared with the paramedian forehead flap, the frontonasal flap avoids a planned secondary procedure and an extensive donor defect. It allows for the coverage of defects at least the size of the Rintala flap and larger defects than the bilobed flap.
本研究调查了与其他局部皮瓣相比，额鼻皮瓣进行鼻尖重建的效果。
纳入10年间所有采用局部皮瓣进行的鼻尖重建病例。回顾性评估缺损大小、皮瓣类型、危险因素、合并症、并发症、修复情况及二次手术情况。术后12个月进行临床随访检查。术前及末次随访时均采用标准投照方式拍摄数码照片，由3名独立检查者评估美学效果，对鼻外形、对称性、瘢痕及皮瓣与鼻皮肤的肤色匹配度采用4分制评分。最后获取患者满意度。
共对68例女性和44例男性进行了112次鼻尖重建，平均年龄71.4±10.2岁。综合考虑缺损大小、个体因素及患者偏好，采用58例额鼻皮瓣、23例林塔拉皮瓣、20例正中旁前额皮瓣和11例双叶皮瓣进行重建。除额鼻皮瓣治疗的患者中动脉高血压发病率较高、糖尿病发病率较低外，各皮瓣类型患者的平均年龄和合并症情况具有可比性。额鼻皮瓣和林塔拉皮瓣重建的缺损大小相同，双叶皮瓣较小，正中旁前额皮瓣较大。不同皮瓣技术的并发症发生率无差异。考虑到正中旁前额皮瓣的计划性二次干预（皮瓣蒂分离），所有皮瓣技术的非计划性矫正频率相当。所有技术的美学效果和患者满意度评分超过90%为非常好或良好。
与正中旁前额皮瓣相比，额鼻皮瓣避免了计划性二次手术及广泛的供区缺损。它能够覆盖至少与林塔拉皮瓣大小相同的缺损，且比双叶皮瓣能覆盖更大的缺损。
