应用鼻翼部上蒂双叶形皮瓣修复鼻下部软组织缺损.docVIP

应用鼻翼部上蒂双叶形皮瓣修复鼻下部软组织缺损 　　[摘要]目的：观察鼻翼部上蒂双叶形皮瓣修复鼻下部小面积软组织缺损的疗效。方法：对11例鼻下部肿物切除后皮肤软组织缺损的患者设计上蒂双叶形皮瓣修复创面，术后随访，观察远期修复效果。其中恶性黑色素瘤1例，皮内痣4例，混合痔5例。结果：本组患者共11例，采用本法修复后所有患者创面Ⅰ期愈合，皮瓣全部成活，术区瘢痕细小，鼻外观满意，通气功能良好，供瓣区创面Ⅰ期愈合，未引起临近组织移位变形，术后随访3～12个月未见肿物复发。结论：鼻翼部上蒂双叶形皮瓣修复鼻下部小面积软组织缺损具有设计简便、操作简单、术后成活率高等优点，可以推广使用。 中国论文网 /6/view-7244990.htm 　　[关键词]鼻翼；双叶皮瓣；上蒂；鼻下部；缺损 　　[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2015）21-0017-03 　　Abstract： Objective To observe the curative effect of repairing the lower small area nasal soft tissue defects with pedicled flap on nasal alae. Methods 11 patients who had suffered from skin and soft tissue defect after resection alar were designed bilobed flap to repair the wound，followed up after operation，and also the forward repair effect were observed.Among them，one case suffered from malignant melanoma，intradermal nevus 4 cases，5 cases mixed hemorrhoid. Results There were 11 patients in this group，all of the patients were healed by first intention after operated， and all flaps survived，the area of scar was small with nasal satisfactory appearance，the ventilation function is good，for disc area Ⅰ healing of the wound，nearby tissue did not cause deformation and displacement of the patients were followed up for 3-12 months postoperatively without recurrence of neoplasm. Conclusion This method has the advantages of simple design，easy operation，and high postoperative survival rate，etc.It can be widely promoted. 　　Key words：alar；bilobed flap；Based on the pedicle；on the lower part of the nose；defect 　　由于鼻下半部皮肤较厚，皮下组织及腺体丰富而缺少弹性，此部位软组织缺损后较难直接拉拢缝合，目前整形外科多采用局部皮瓣修复，如鼻唇沟皮瓣、Limberg菱形皮瓣[1]、Zitelli双叶皮瓣、交错皮瓣等。2012年7月-2015年1月，笔者运用鼻翼部双叶形皮瓣修复鼻下部小面积软组织缺损11例，术后效果满意，现报道如下。 　　1 资料和方法 　　1.1 临床资料 　　本组患者共11例（男性2例，女性9例），年龄22～60岁，平均（39.14±6.17）岁。病变区均位于鼻下部，其中恶性黑色素瘤1例，皮内痣4例，混合痔5例（术后病理检验证实）；病变切除后缺损区为圆形或椭圆形，缺损面积最小者0.6cm×1.0cm，最大者1.3cm×1.2cm，平均（0.67±0.12）cm×（1.30±0.22）cm。所有缺损均为皮肤全层缺损，深达皮下浅筋膜层。 　　1.2 麻醉方法 　　本组患者全部采用1%的利多卡因（含1：200 000盐酸肾上腺素）局部浸润麻醉。 　　1.3 手术方法 　　1.3.1 皮瓣设计：设计拟切除病变区，一般良性肿瘤手术切除范围含