外鼻烧伤后缺损及瘢痕畸形修复.docVIP

外鼻烧伤后缺损及瘢痕畸形修复(解放军三0四医院烧伤整形科　北京　100037) 陈宝驹　男,1943年生,1968年吉林医科大学毕业,现任解放军304医院烧伤整形外科主任,主任医师。 [摘　要]　目的:探讨鼻烧伤缺损与畸形的特点及其整复治疗。　方法:将近20年来收治的鼻烧伤畸形及其修复进行归类,除采用皮片移值等修复各种瘢痕畸形以外,采用皮瓣包手桡动脉细小皮支前臂岛状皮瓣、植皮后形成的额部血管化皮瓣;对缺乏传统方法修复条件的病例,采用髂腰部残存皮肤预制薄皮瓣转移进行鼻再造。　结果:75例鼻部烧伤畸形,经修复后功能与外形获得恢复与改善。　结论:依畸形情况选择适宜的方法,对合并面部瘢痕的病例,应待鼻周畸形整复效果稳定后施行鼻部整复术。 [关键词]　鼻整形　烧伤　瘢痕　缺陷 [中图分类号]R623.2　[文献标识码]A　[文章编号]1008-6455(2000)05-0372-02 RHINOPLASTY:DEFORMITIES OF BURNED SCARS AND DEFECTS CHEN Bao-ju　XU Ming-huo　JING Sa (Depart burn-plastic surgery,304th hospital PLA(Beijing 100037) [Abstract]　Objective:To evaluate characteristics of burned nasal deformities and rhinoplasty.　Methods:〖WT5”BZ〗Burned nasal deformities and plastic methods of 75 patients enrolled into our hospital since 1980 were classified.Besides skin graft,varied skin flaps such as the island forearm flaps based on tiny cutaneous branches of the radical vessel and the revascularized forehead flap were applied.The thin flap prefabricated with only normal iliolumbar skin was used for reconstruction of the nose in one patient who was lack of condition of conventional repair methods.　Results:Significantly improved function and appearance were achieved in all 75 nasal plastic operations.　Conclusions:Appropriate choice of rhinoplasty procedures according to features of nasal deformities is important.Nasal plastic operations must be done until the plastic results of nasal surrounding deformities have been stabilized. [Key words]　Rhinoplasty　Burn　Scar　Defect 鼻以其居中而突出的显要位置,在面部诸器官中更容易遭受烧伤,发生畸形后更容易影响容颜和谐。自1979年3月至1999年3月,我们对75例烧伤后不同程度的鼻部畸形进行相应的修复,结果满意。现就本组病例畸形特点进行综合分析,并对其中较严重或复杂畸形的修复方法予以简要介绍。 1　临床资料?75例中,男48例,女27例;年龄7岁～52岁;鼻部畸形;单纯鼻背瘢痕11例,鼻背瘢痕与鼻翼缺损5例,鼻背瘢痕与面部瘢痕19例(其中9例合并鼻翼缺损),鼻损毁与面部瘢痕18例,单纯鼻翼缺损10例,鼻孔狭窄8例,鼻端与鼻小柱畸形4例。 2　修复方法?全厚皮片移值38例,主要用于各类鼻背瘢痕;中厚皮片移植3例,修复鼻孔狭窄;真皮下血管网皮片移值2例,修复鼻端小柱缺损;耳廓复合组织移植7例,修复鼻孔狭窄3例和鼻翼缺损4例;瘢痕切除缝合2例及V-Y成形1例,分别用于局限性鼻背瘢痕及鼻小柱挛缩畸形;劈裂术3例,修复鼻唇粘连1例和鼻孔狭窄2例(其中1例合并鼻翼缺损);额部皮瓣3例,修复合并鼻翼缺损的鼻背瘢痕1例与合并面部瘢痕的鼻损毁2例(其中1例额面部曾接受植皮,于