Meyer R
Centre de Chirurgie Plastique, Lausanne, Switzerland.
Aesthetic Plast Surg. 1994 Fall;18(4):345-55. doi: 10.1007/BF00451339.
In this time of increasing occurrence of septal perforations caused by cocaine abuse, the plastic surgeon who deals mainly in rhinoplasty must learn to treat these defects with sophisticated methods. Too many septal perforations, especially large ones, are not treated because the surgical techniques are difficult. This article describes and illustrates two methods that close all kinds of perforations. Local flaps should be considered obsolete. A perforation up to 4 cm in diameter must be repaired in one step. This includes wide dissection of the mucoperichondrium and mucoperiosteum, suture of the hole on both sides, and interposition of parietal fascia or cartilage, sometimes with the help of bilateral small buccal flaps to cover the gap between the columella and the dissected mucoperichondrium containing the closed perforation on both sides. For closure of perforations greater than 4 cm in diameter, a three-step procedure which uses a composite three-layered buccal flap including ear concha cartilage is described. In the second step, the spoon-shaped flap is fed into the nasal cavity to fill the septal defect. The third step divides the pedicle. In many cases a unilateral or bilateral alotomy or the section of the columellar base may facilitate the suture of the flaps.
在因可卡因滥用导致鼻中隔穿孔发生率不断上升的这个时期，主要从事鼻整形手术的整形外科医生必须学会用复杂的方法来治疗这些缺损。太多的鼻中隔穿孔，尤其是大的穿孔，没有得到治疗，因为手术技术难度大。本文描述并说明了两种闭合各种穿孔的方法。局部皮瓣应被视为过时的方法。直径达4厘米的穿孔必须一次性修复。这包括广泛剥离鼻中隔软骨膜和骨膜，两侧缝合穿孔，并用顶叶筋膜或软骨进行插入，有时借助双侧小颊部皮瓣来覆盖鼻中隔与剥离的鼻中隔软骨膜之间的间隙，鼻中隔软骨膜两侧已闭合穿孔。对于直径大于4厘米的穿孔闭合，描述了一种三步法，该方法使用包括耳甲软骨的复合三层颊部皮瓣。在第二步中，将匙形皮瓣送入鼻腔以填充鼻中隔缺损。第三步切断蒂部。在许多情况下，单侧或双侧鼻翼切开术或鼻中隔基部的切断可能有助于皮瓣的缝合。
