Cozzi Silvia, Codazzi Denis, Cherubino Mario, Valdatta Luigi, Carminati Marcello
Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
Plast Surg (Oakv). 2024 Nov;32(4):684-695. doi: 10.1177/22925503231167445. Epub 2023 Apr 4.
The nose is the most critical aesthetic element of the face and even the smallest loss of substance can create a deformity of concern. The forehead flap has been the workhorse for nasal reconstruction for centuries but requires multiple surgical steps and leads to prominent donor-site scarring. The nasolabial flap allows a single-step reconstruction with a donor-site scar concealed in the nasolabial crease but is conventionally designated for small defects involving the ala. The authors analysed all surgical records of patients undergone nasal reconstruction by nasolabial flap between May 2005 and December 2021 by the Plastic Surgery Unit of a major regional hospital in Lombardy. Defects were classified according to Burget's subunit principle and the 3-component approach. Reconstruction features and finesses were reported and analysed. In the 16-year period under analysis, 378 patients with nasal defects of various aetiologies received nose reconstruction by nasolabial flap. All nasal subunits were involved; 20 patients had multisubunit defects. In all the cases the reconstruction with nasolabial flap, alone or combined with other solutions, was intended to be one-stage. The authors present several tips and tricks about preoperative planning and design, choice of the pedicle, flap harvesting and sculpting with preservation/restoration of grooves and convexities, conjoining multiple flaps, downsizing extensive defects by a rhinoplasty-like framework reduction. With a careful planning and refined technique, the range of application of the nasolabial flap can include defects involving any nasal subunit and larger and/or multisubunit defects.
鼻子是面部最关键的美学元素，即使是最微小的组织缺失也可能造成令人担忧的畸形。几个世纪以来，额部皮瓣一直是鼻再造的主要手段，但需要多个手术步骤，且会导致明显的供区瘢痕。鼻唇沟皮瓣可进行单步再造，供区瘢痕隐藏在鼻唇沟内，但传统上适用于累及鼻翼的小缺损。作者分析了2个主要地区医院整形科在2005年5月至2021年12月期间采用鼻唇沟皮瓣进行鼻再造的所有患者的手术记录。根据伯杰的亚单位原则和三分法对缺损进行分类。报告并分析了再造的特点和技巧。在分析的16年期间，378例各种病因导致鼻缺损的患者接受了鼻唇沟皮瓣鼻再造。所有鼻亚单位均有累及；20例患者存在多亚单位缺损。在所有病例中，鼻唇沟皮瓣单独或与其他方法联合进行的再造均为一期手术。作者介绍了一些关于术前规划与设计、蒂的选择、皮瓣切取与塑形（保留/恢复沟和凸）、联合多个皮瓣、通过类似鼻整形的框架缩减来缩小大面积缺损等方面的技巧和窍门。通过精心规划和精湛技术，鼻唇沟皮瓣的应用范围可包括累及任何鼻亚单位的缺损以及更大和/或多亚单位缺损。
