Wintsch K
Handchir Mikrochir Plast Chir. 1986 Jul;18(4):231-5.
For the reconstruction of the nostril a nasolabial flap is recommended. According to the method of Pers (1967), the upper part of the flap is used for lining and the lower part for the outside coverage of the defect. In order to avoid lateral traction on the nostril, the author recommends that a small triangular flap with an inferior pedicle is left between the nasolabial flap and the nostril. For total reconstruction of the nose, a frontal flap with a primary cantilever bone graft as described by Millard (1966) is suggested. We advise to take one half of forehead skin. This gives a less obvious donor site and enough length in the diagonal direction for the dorsum of the nose and the columella. For the leprotic nose it is emphasized that no skin loss is present, there is only a loss of lining and support. In all advanced cases a large septal defect is encountered. The reliable postnasal inlay of Gillies is mentioned but the draw back to this method is that the care of the postnasal prosthesis may be difficult for leprosy patients with disabled hands. Secondary bone grafting after this procedure has a high failure rate because of infection. For these reasons the reconstruction of lining by two nasolabial flaps according to Farina (1957) is described. The author has regularly used this method with a primary cantilever graft. A modification is again suggested. A small triangular skin flap is raised with the ala, thus avoiding lateral traction on the nostrils after closure of the donor site.
对于鼻孔重建，推荐使用鼻唇瓣。根据佩尔斯（1967年）的方法，瓣的上部用于衬里，下部用于缺损的外部覆盖。为避免对鼻孔的侧向牵拉，作者建议在鼻唇瓣和鼻孔之间保留一个带下方蒂的小三角形瓣。对于全鼻重建，建议采用米勒德（1966年）所描述的带一期悬臂骨移植的额瓣。我们建议取用一半的额部皮肤。这样供区不太明显，且在鼻背和鼻小柱的对角线方向有足够的长度。对于麻风性鼻，需要强调的是不存在皮肤缺失，只是衬里和支撑结构缺失。在所有晚期病例中，都会遇到较大的鼻中隔缺损。提及了吉利斯可靠的鼻后嵌体，但该方法的缺点是，对于手部残疾的麻风患者，鼻后假体的护理可能困难。此手术后的二期骨移植因感染而失败率很高。出于这些原因，描述了根据法里纳（1957年）的方法用两个鼻唇瓣重建衬里。作者经常使用这种带一期悬臂移植的方法。再次建议进行改良。掀起一个与鼻翼相连的小三角形皮瓣，这样在供区闭合后可避免对鼻孔的侧向牵拉。
