额部扩张皮瓣法半鼻再造术修复部分鼻缺损(1)
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[摘要]目的：探讨应用扩张额部皮瓣行半鼻再造术修复部分鼻缺损的效果。方法：2008年6月～2010年12月，收治部分鼻缺损患者5例，男1例，女4例，均采用额部扩张皮瓣法半鼻再造术修复。手术分3期进行：Ⅰ期行额部额肌下扩张器置入术皮肤扩张；Ⅱ期行额部扩张皮瓣转移半鼻再造术；Ⅲ期行鼻根部皮瓣断蒂修整术。结果：术后患者均愈合良好，无明显并发症发生。5例患者均获随访，随访时间6月～1年。再造鼻形态满意，颜色、质地与周围皮肤较为匹配，额部供区无明显瘢痕及畸形。结论：额部扩张皮瓣法行半鼻再造术修复鼻缺损，手术方法简单可靠，术后效果满意。
[关键词]鼻缺损；额部扩张皮瓣；鼻再造；
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)09-1327-03
Half nasal reconstruction using expanded forehead skin flap for repairing partial nose defect
YU Xiao-bo,ZHAO Yan-yong,JIANG Hai-yue,PAN Bo,FAN Fei,ZHUANG Hong-xing,JI Dong-shuo
(The 7th Department,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100144,China)
Abstract:ObjectiveTo explore the result of the method of half nose reconstruction using an expanded forehead flap for repairing nose defect.MethodsFrom June 2008 to December 2010, 5 patients including 1 male and 4 female with partial nose defect were treated with the method. The technique consists of three stages: Tissue expanders were implanted under the muscle of forehead and extended forehead skin expansion, single-stage nasal contouring with expanded forehead skin flap rotation, and pedicle restoration.ResultsAll patients healed without obvious complications. All 5 patients have been followed from 6 months to 1 year. The reconstructed noses had satisfactory shape and good match to adjacent skin in color and texture. There were no obvious scar and deformity in the donor site of forehead.ConclusionThe half nose reconstruction using expanded forehead skin flap for repairing nose defect is a simple and reliable method with satisfactory result.
Key words:nasal defect; expanded forehead skin flap; nose reconstruction
额部皮瓣因皮肤颜色和质地与鼻部相接近，扩张后供区畸形减少，扩张皮瓣厚度较薄质地更利于修复时皮瓣塑形，因此应用额部扩张皮瓣皮瓣进行全鼻再造修复鼻缺损已经成为整形外科医师的首选术式。对于部分鼻缺损患者，多数学者也主张应用额部扩张皮瓣行全鼻再造术修复[1-2]。但尚有一部分鼻缺损患者希望保留正常残余鼻组织，拒绝全鼻再造，而残余正常鼻结构作为对照增加了手术的难度。为修复此类鼻缺损，2008年6月～2010年12月我们收治部分鼻缺损患者5例，应用额部扩张皮瓣行半鼻再造术修复，效果良好，报道如下。
1临床资料
1.1 一般资料：本组患者男1例，女4例。年龄16～35岁，平均27岁。浓硫酸烧伤后瘢痕愈合1例，血管瘤术后鼻部分缺失1例，车祸伤后鼻部分缺失1例，烧伤后鼻缺损2例。缺损范围1cm×1cm～2cm×2cm，病程8个月～2年。
1.2 手术方法：手术分为三期。
1.2.1 Ⅰ期：埋置额部扩张器：根据患者额部宽度选择150～300ml的柱形或圆形扩张器。病人平卧位，0.5%利多卡因加1:10万去甲肾上腺素局部注射浸润麻醉术区。在额部发际线内3～5cm处做3cm切口，于帽状腱膜下骨膜表面之间剥离，剥离的腔隙应较扩张器略大 ......
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