创伤性鼻部分及全部缺损修复.doc

创伤性鼻部分及全部缺损修复[摘要]目的：依据创伤性鼻缺损的形状和大小，选择相应的修复方案，并探讨各种方法修复后的效果。方法：全鼻缺损的修复采用：①前臂皮瓣+局部皮瓣；②额部扩张后皮瓣；③上臂皮管转移。 鼻部分缺损的修复采用：①鼻唇沟皮瓣；②耳郭复合组织移植；③全厚皮移植等。结果：38例采用6种不同的方法均得以修复，全鼻缺损1例因鼻区与上颌窦洞穿性缺损处的感染致鼻部分坏死，经换药及再次修复愈合。鼻部分缺损经皮瓣、耳郭复合组织及全厚皮片移植修复，均全部成活外观满意。结论：鼻部分及全部缺损的程度各不相同，但只要依据损伤的大小选择相应的修复方法，就能达到较佳的鼻外形，鼻外观恢复也较为满意，但用远位的皮瓣修复后表面色泽反差明显但不影响整体效果。 [关键词]创伤；鼻缺损畸形；修复 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2007）10-1387-03 Repair of the traumatic total or partial defect of nose ZHANG Xu-sheng,LIU Yi,ZHANG Bin (Department of Burns and Plastic Surgery,Lanzhou General Hospital,Lanzhou Command,PLA, Lanzhou 730050,Gansu,China) Abstract:ObjectiveTo explore the effect on the repair of the traumatic defect of nose, and choose the most suitable surgenetic treatments on different shaps and areas.MethodsThe repairing ways of the total defect of nose were forearm skin flap and local skin flapgrafting, forehead expanded skin flapgrafting and forearm tubed flapgrafting. The repairing ways of the partial defect of nose were nasolabial sulcus skin flapgrafting, free grafting of auricle composite tissue and full-thickness skin grafting.RrsultsThe 48 cases of defect of nose were repaired by the six surgenetic ways. One case appeared focal necrosis in skin flap was used to repair of through sinus and through total defect of nose. The wounds were repaired in the secondary operation after controling the infection by dressing chang. The appearance of the partial defec of the nose which were repaired by skin flap grfting, free grafting of auricle composite tissue and full-thickness skin grafting were satisfaction.ConclusionTo choose the suitable repaired ways could reconstruct the nose and accquire the satisfactary appearance by thesize and level of the defect of nose. But the appearance of noses with induvidual cases were effected on the pigmentation and depigmentation. Key words: traumatic；defect of nose；repair 鼻部分及全部缺损多源于各种外伤，最早的鼻修复法是“印度鼻”方法，经过多年实践过程中的经验积累，其治疗方法愈来愈多。我科根据缺损范围层次及毗邻结构的不同，采用6种方法修复38例，均