应用自体真皮脂肪瓣修复陈旧性鼻眶筛骨骨折后凹陷畸形(1)
[摘要]目的：探讨自体真皮脂肪瓣在修复陈旧性外伤性鼻根凹陷伴眉弓凹陷的可行性及效果。方法：回顾性分析2010年5月至2014年1月在我院以自体真皮脂肪瓣作为填充材料的10例鼻眶筛骨骨折后鼻根部及眉弓处塌陷患者。切取自体腹部真皮脂肪瓣(面积7.0cm×5.0cm×1.0cm到3cm×2cm×1cm不等)沿2处眉上切口填充于凹陷处并固定。随访观察时间平均4.3个月。结果：9例患者眉弓及鼻外形改善满意，1例过度充填致眉弓局部略凸出，但效果较修复前凹陷较好。10例患者术后移植组织存活良好，切口均I期愈合，痕迹不明显。吸收率约为22.2%～46.5%。结论：自体真皮脂肪瓣修复陈旧性外伤性鼻根凹陷伴眉弓凹陷，恢复速度较快，预后较好，排异反应较少。
[关键词]自体真皮脂肪瓣；鼻根伴眉弓凹陷；陈旧性鼻眶筛骨骨折；吸收率
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2014)22-1871-04
Application of autologous dermal-fat flap in the reconstruction of collapse in neglected nasal-orbital ethmoid fracture
LI Tian，LIN Quan，GUO Jingdong，WENG Jie，ZHANG Duo
(Department of Plastic and Aesthetic Surgery，First Hospital of Jilin，University， Jilin 130021， Changchun，China)
Abstract： Objective To evaluate the feasibility，rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the reconstruction of nasal dorsum and superciliary arch collapse after neglected nasal-orbital ethmoid fracture. Methods From May 2010 to January 2014，ten of the patient's dermal-fat composite tissue blocks (from about 7.0cm× 5.0 cm×1.0cm to 3.0cm× 2.0 cm×1.0 cm ) were removed from the groin as filling materials.Trimming flaps and filling depression through the two incisions of depression area which were just above the superior border of the two eyebrows.After 3-6 months，follow-up，4.3 months on average， all patients were satisfied for the improvement of superciliary arch and nose shape. Results A total of 10 cases accepted this surgery，9 of them were satisfied and all patientes were followed up for 3-6 months postoperatively，the dermal-fat composite tissue survived well，and the incisions were healed in stage I and the incision trace was not obvious.To calculate the absorption rate of about 22.2%-46.5% by using IPP to deal with data. Conclusion Implantation of autologous dermal-fat flap to reconstruct nasal dorsum and superciliary arch collapse after old nasal-orbital ethmoid fracture leads to quicker recovery，a good prognosis with no rejection，and easily accepted by patients.
Key words：autologous dermal-fat flap；nasal dorsum and superciliary arch collapse；old nasal-orbital ethmoid fracture； absorption rate
鼻眶筛骨骨折是面部骨折中较为常见的类型，外伤所致鼻眶筛骨骨折多伴随颅骨及颅内损伤，多因无法行Ⅰ期手术而错过最佳手术时机，导致面部凹陷等畸形形成，陈旧性鼻眶筛骨折易引起鼻根及眉弓处凹陷，严重影响患者美观。有学者应用计算机辅助导航系统和三维钛网修复凹陷畸形，但上述技术对设备具有较高的要求且成本较高，可能并不适合我国凹陷修复畸形的需要。此外，通过人工合成材料充填以消除凹陷恢复面部正常的轮廓与外形[1-2]，可能由于外源性物质的引入导致包括免疫反应在内的副反应的发生。因此，临床上多采用自体组织移植填充面部凹陷。目前临床上较常用自体脂肪颗粒注射方法[1]，存在对结构把握的精确度较差，吸收率较高等问题。因此，笔者所在美容科采用自体真皮脂肪瓣对陈旧性鼻篩眶骨骨折所导致的凹陷畸形进行修复，取得良好效果，现报道如下。 (李甜等)
[关键词]自体真皮脂肪瓣；鼻根伴眉弓凹陷；陈旧性鼻眶筛骨骨折；吸收率
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2014)22-1871-04
Application of autologous dermal-fat flap in the reconstruction of collapse in neglected nasal-orbital ethmoid fracture
LI Tian，LIN Quan，GUO Jingdong，WENG Jie，ZHANG Duo
(Department of Plastic and Aesthetic Surgery，First Hospital of Jilin，University， Jilin 130021， Changchun，China)
Abstract： Objective To evaluate the feasibility，rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the reconstruction of nasal dorsum and superciliary arch collapse after neglected nasal-orbital ethmoid fracture. Methods From May 2010 to January 2014，ten of the patient's dermal-fat composite tissue blocks (from about 7.0cm× 5.0 cm×1.0cm to 3.0cm× 2.0 cm×1.0 cm ) were removed from the groin as filling materials.Trimming flaps and filling depression through the two incisions of depression area which were just above the superior border of the two eyebrows.After 3-6 months，follow-up，4.3 months on average， all patients were satisfied for the improvement of superciliary arch and nose shape. Results A total of 10 cases accepted this surgery，9 of them were satisfied and all patientes were followed up for 3-6 months postoperatively，the dermal-fat composite tissue survived well，and the incisions were healed in stage I and the incision trace was not obvious.To calculate the absorption rate of about 22.2%-46.5% by using IPP to deal with data. Conclusion Implantation of autologous dermal-fat flap to reconstruct nasal dorsum and superciliary arch collapse after old nasal-orbital ethmoid fracture leads to quicker recovery，a good prognosis with no rejection，and easily accepted by patients.
Key words：autologous dermal-fat flap；nasal dorsum and superciliary arch collapse；old nasal-orbital ethmoid fracture； absorption rate
鼻眶筛骨骨折是面部骨折中较为常见的类型，外伤所致鼻眶筛骨骨折多伴随颅骨及颅内损伤，多因无法行Ⅰ期手术而错过最佳手术时机，导致面部凹陷等畸形形成，陈旧性鼻眶筛骨折易引起鼻根及眉弓处凹陷，严重影响患者美观。有学者应用计算机辅助导航系统和三维钛网修复凹陷畸形，但上述技术对设备具有较高的要求且成本较高，可能并不适合我国凹陷修复畸形的需要。此外，通过人工合成材料充填以消除凹陷恢复面部正常的轮廓与外形[1-2]，可能由于外源性物质的引入导致包括免疫反应在内的副反应的发生。因此，临床上多采用自体组织移植填充面部凹陷。目前临床上较常用自体脂肪颗粒注射方法[1]，存在对结构把握的精确度较差，吸收率较高等问题。因此，笔者所在美容科采用自体真皮脂肪瓣对陈旧性鼻篩眶骨骨折所导致的凹陷畸形进行修复，取得良好效果，现报道如下。 (李甜等)