鼠咬伤后鼻缺损的分类与修复-第三军医大学学报.doc

鼠咬伤后鼻缺损的分类标准及手术方式初探 李 喆，戴 霞，李世荣，王珍祥，毋巨龙，陈 亮（400038重庆，第三军医大学西南整形美容外科医院） [摘要]　目的　探讨鼠咬伤后鼻缺损的分类标准，以指导临床修复方法的选择。方法　回顾性分析1998年10月至2010年4月我院收治的26例鼠咬伤后鼻缺损患者。依据鼻缺损的部位及范围对其进行分类，并探讨所采用的“鼻唇沟皮瓣”、“耳廓复合组织瓣”、“上臂内侧管状皮瓣”、“前额扩张皮瓣”等术式修复鼻缺损的手术效果。结果　将鼠咬伤后鼻缺损分为四类：Ⅰ类，鼻尖缺损；Ⅱ类，单纯鼻翼缺损；Ⅲ类，鼻尖和部分鼻翼缺损；Ⅳ类，全鼻缺损。并根据分区修复的方法对其进行修复，经过临床６个月至３年随访，26例患者均获得满意修复效果。结论　鼠咬伤后鼻缺损对患者生理及心理影响极大，对其进行科学分类以助于选择最佳手术方式。 [关键词]　鼠；鼻缺损；鼻唇沟皮瓣；耳廓复合组织瓣；上臂内侧管状皮瓣；额部扩张皮瓣； [中图法分类号] [文献标志码]A Preliminary studies on classification of nasal defect caused by rat Li Zhe，Shirong，，， Chen liang ( The Southwestern Plastic and Aesthetic S urgery Hospital，The Third Military Medical University，Chongqing 400038，China)Abstract] Objective 　To the classification and the treatment of nasal defect caused by rat. Methods From October 1998 to April 2010，we have been received 26 patients of nasal defect caused by rat，they were successfully repaired ，the The treatment including nasal-label flap ， auricular composite tissue graft ， upper arm flap and outstretched frontal flap. Results 　 were divided into 4 types based on their defective position and range.Ⅰ，defect of nasal tip，defect of nasal ala，，defect of nasal tip and ala，，defect of entire nose. hey were successfully repaired with satisfactory results. Conclusion 　Thenasal defects caused by rat should be correlated with the classification so as to achieve satisfactory results. [Key words] Rat；Nasal defect；Nasal-label flap；Auricular composite tissue graft；Upper arm flap；Outstretched frontal flap [通信作者] 姓名：毋巨龙；电话：023E-mail：wjl3310@ Corresponding author：Wu Julong ；Tel：86-023E-mail：wjl3310@  1.2 治疗方法 1.2.1 鼻唇沟皮瓣　应用鼻唇沟皮下蒂岛状皮瓣修复Ⅰ类缺损3例，Ⅱ类缺损2例，沿缺损边缘切开，修整缺损处瘢痕，使其能与移植皮瓣良好接触，以疾患偏向的鼻侧中点为中心，设计一鼻唇沟稍远处的皮瓣，皮瓣较缺损略大，先在蒂部皮肤切口上切开皮肤，仅达真皮下层，向两侧做锐性剥离，掀开真皮瓣，露出皮下蒂，按皮瓣的宽度切开蒂部及皮瓣达深筋膜，将皮瓣及蒂部掀起，自蒂部近端向鼻端缺损处分离皮下隧道，将皮瓣通过隧道转移至鼻端缺损处，与缺损部四周创缘缝合，供区直接拉拢缝合[4]。 1.2.2耳廓复合组织瓣　应用耳廓复合组织瓣游离移植修复Ⅰ类缺损1例，Ⅱ类缺损4例，将缺损鼻翼与周围皮肤向内侧翻转，作为部分衬里，使内侧创缘尽可能位于鼻翼与鼻端交界处，外侧创缘位于鼻翼的外1/3区域内，甚至达到鼻翼外侧角，衬里的缺损宽度应