应用扩张额部斜行皮瓣修复鼻部缺损.docVIP

应用扩张额部斜行皮瓣修复鼻部缺损[摘要]目的：探讨扩张一侧滑车上动脉的额部斜行皮瓣修复鼻部缺损的效果。方法：对13例伴有鼻尖鼻翼大部分缺损的病例，在额部一侧滑车动脉走行区域下斜向植入80～120ml不同容积扩张器，经过2～3.5个月的扩张，获得多余的皮肤软组织。设计滑车上动脉额部斜行薄皮瓣转移修复鼻部缺损，对鼻支架破坏的病例同期植入肋软骨支架或鼻假体，1个月后断蒂并对鼻外形进行修整。结果：全部病例扩张顺利，转移的皮瓣成活。获得足够的鼻长度、鼻尖突度，修复效果满意，额部供区无明显瘢痕遗留。结论：该方法能获得比较理想的修复效果，应作为修复伴有鼻尖鼻翼大部分缺损修复的首选方法。 [关键词]滑车上动脉；额部皮瓣；鼻缺损；鼻再造；修复 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2011）07-1041-03 Repair of nasal defects by expanded forehead oblique flap WANG Ji-hua,ZHU Li-kun,YANG Yun,XIAO Hong,HE Yong-jing，LI Ying,ZHANG Jing-bo (Department of Plastic Surgery, The Second Affiliated Hospital of Kunming Medical College,Kunming 650101,Yunnan,China) Abstract:ObjectiveTo discuss the effect of repairing nasal defects by expanded forehead oblique flap with one sidesupratrochlear artery.MethodsFor 13 patients with nasal tip and nasal ala defects. 80～120 ml expanderwas implanted under one side supratrochlear artery of the forehead skin tissue.After expansion of 2～3.5 months,the flap of the supratrochlear artery was transferredand the nasal defect was repaired. rib cartilage or nasal prosthesis was implanted for the patient whose nose frame was destroyed. One month later, the pedicle of flap was cut and nasal shape was trimmed.ResultsAll patients were successfully,adequate nasal length and nasal tip were obtained.We have satisfactory results. no obvious scars in the frontal supply area.ConculsionThis method could obtained satisfactory results,and should be first approach for repairing larg defects included nasal tip and nasal ala. Key words: supratrochlear artery;forehead flap;nasal defects;nasal reconstruction;repair 鼻尖尤其是伴有鼻小柱、鼻翼的鼻大部分缺损后修复是整形外科临床上的难题，多年来整形外科医生一直在寻找一种较为理想的手术方法。2005年～2010年间，我科对鼻尖,或伴有鼻小柱、鼻翼的鼻大部分缺损的13例患者，应用扩张一侧滑车上动脉的额部斜行皮瓣修复，取得比较理想的手术效果，报道如下。 1资料和方法 1.1 临床资料：本组病例13例，男9例，女4例，年龄13～52岁。鼻尖缺损3例，鼻尖及鼻小柱、鼻翼大部分缺损9例，一侧鼻翼、鼻尖伴上唇缺损1例。缺损原因：锐器切割伤11 例，人咬伤1例，黑熊咬伤1例。全部额部供区皮肤良好。 1.2 手术方法 1.2.1 扩张器植入：在发际处做与扩张器远端平行的切口3～4cm,直达帽状腱膜深面，钝性剥离形成稍大于扩张器的腔隙，近端在滑车上动脉蒂部下方，在额部一侧滑车上动脉走行区斜行