McAllister Lauren, Thornton James
Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Semin Plast Surg. 2024 Nov 4;38(4):297-303. doi: 10.1055/s-0044-1791564. eCollection 2024 Nov.
Complex nasal reconstructions require adequate planning with an accurate estimation of the time necessary to perform each stage. Reconstructions of the entire nose, multiple subunits, or a substantial subunit typically require lining replacement and cartilage grafting. Securing the lining prior to a staged reconstruction is preferred, but options such as the Menick folded paramedian forehead flap (PMFF) allow for lining coverage at the time of the first stage. The free radial forearm flap and the PMFF remain the gold standard for the initial lining coverage. Cartilage grafting is fundamental to complex nasal reconstructions and can be secured in either the first or the second stage. Staged reconstructions require thorough patient education, patience from both the patient and the surgeon, and an understanding that final revisions may be necessary.
复杂的鼻再造需要进行充分的规划，并准确估计每个阶段所需的时间。全鼻、多个亚单位或一个较大亚单位的再造通常需要更换衬里和软骨移植。在分期再造之前固定衬里是首选方法，但诸如梅尼克折叠旁正中前额皮瓣（PMFF）等方法可在第一阶段实现衬里覆盖。游离桡侧前臂皮瓣和PMFF仍然是初始衬里覆盖的金标准。软骨移植是复杂鼻再造的基础，可以在第一阶段或第二阶段进行固定。分期再造需要对患者进行全面的教育，患者和外科医生都要有耐心，并理解可能需要进行最终修复。
