额部扩张皮瓣半鼻再造术.docVIP

额部扩张皮瓣半鼻再造术濮礼臣　男，1946年生，1970年毕业于天津医科大学医疗系，天津市口腔医院、天津市整形外科医院整形外科主任、主任医师。发表论文20余篇，获科技成果奖5项。［摘要］目的：介绍应用额部扩张皮瓣进行半鼻再造的体会。方法：总结9例采用扩张后的额部皮瓣转移后作为再造鼻的皮肤覆盖，局部翻转皮瓣作为鼻腔衬里，移植肋软骨或耳甲软骨重建鼻支持组织的手术方法。〖HT5”H〗结果：9例中8例获得满意效果，再造半鼻与健侧基本对称。1例额部扩张皮瓣远端淤血坏死。结论：应用额部扩张皮瓣进行半鼻再造是可行的。 ［关键词］半鼻缺损半鼻再造术皮肤软组织扩张术额部皮瓣 ［中图分类号］R765.9［文献标识码］A［文章编号］1008-6455(2001)01-0047-02 THE EXPERIENCE OF HEMINASAL RECONSTRUCTION WITH EXPANDED FOREHEAD FLAP PU Li-chenZHU Guang-huiJIN Hui-ling et al Tianjin Plastic Surgery Hospital.Tianjin 300041 ［Abstract］Objective：To present the experience of heminasal reconstruction with the expanded forehead flap.Methods：9 patients with congenital or acquired heminasal defect were treated by heminasal reconstruction,in which expanded forehead flaps were transposed to resurface the defected half of nose,local skin flaps based on the defect margin were reversed as the lining flaps to close the full thickness defect at the nasal bridge or to resurface the inner side of the ala,and the conchal or costal cartilage grafts were transplanted to reconstruct the nasal supportive structrue.〖WT5”HZ〗Results：Out of the 9 cases of heminasal reconstruction with the expanded forehead flaps,in 8 cases the results were satisfactory.In l case the venostasis and loss of distal end of forehead flap occurred.Conclusion：The heminasal reconstruction with expanded forehead flap for repair of heminasal defect is available. ［Key words］Heminasal defectSkin soft tissue expansionForehead flapHeminasal reconstruction 以往认为鼻尖鼻中隔基本完好的半鼻缺损，可考虑再造半鼻，缺损超过中线或鼻尖已缺损时应考虑全鼻再造〔1〕。笔者自1991年以来在9例半鼻缺损的整复中，3例鼻尖缺损稍越过中线。用额部扩张皮瓣进行半鼻再造。本组病例表明，再造侧半鼻与健侧半鼻的对称与协调是取得半鼻再造良好的美学效果的关键，在手术设计和操作中应充分考虑。 1临床资料 本组共9例，男性6例，女性3例，年龄6岁～41岁。其中先天性右侧半鼻缺损伴前鼻孔闭锁1例，(图1)外伤性半鼻缺损5例，(图2)烧伤后半鼻缺损1例，感染后半鼻缺损合并鼻背洞穿性缺损1例，肿瘤切除及放疗后半鼻缺损1例。后天获得性半鼻缺损的患者都有不同程度的鼻下端复合组织缺损，鼻背、鼻尖、鼻翼、鼻小柱形态残缺，并有广泛瘢痕，由于瘢痕挛缩使鼻下端偏向患侧，鼻尖鼻小柱歪斜。先天性半鼻缺损患儿的右侧半鼻完全缺如，前鼻孔及鼻道闭锁，健侧鼻尖向对侧偏斜。 2手术设计和操作方法 2.1额部皮肤软组织扩张术本组病例按患者额部的宽度，鼻部缺损的大小选用100ml～180ml的圆形或椭圆形扩张囊，通过发际内长约4cm横行切口，将扩张囊植入额肌与额骨