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目的总结应用前额扩张带蒂皮瓣行全鼻再造的手术方法和临床效果。方法2002年9月-2007年12月,收治因外伤或动物咬伤致鼻缺损23例。男8例,女15例;年龄19～37岁,平均27岁。全鼻缺损4例,鼻尖、鼻小柱及单侧鼻翼缺损6例,鼻尖、鼻小柱及双侧鼻翼缺损13例。病程2～24年。一期手术行前额区皮肤扩张术,二期于额部设计以一侧滑车上动脉为蒂的三叶皮瓣,切取范围7cm×6cm～8cm×7cm,联合上唇再造鼻小柱部位大小为1.0cm×0.8cm～1.0cm×1.0cmU形皮瓣行鼻再造。其中8例于全鼻再造术后6个月行蒂部整复术。结果术后23例患者皮瓣均顺利成活,切口均Ⅰ期愈合。供区Ⅰ期愈合。患者均获随访,随访时间9～45个月,平均19个月。再造鼻外形良好,色泽与邻近组织相近,鼻通气功能良好。额部供区仅留线状瘢痕。结论扩张前额带蒂皮瓣全鼻再造术安全、可靠,是全鼻再造的一种有效方法。
Objective To summarize the surgical methods and clinical effects of total nasal reconstruction with forehead expansion pedicled flaps. Methods From September 2002 to December 2007, 23 cases of nasal defects caused by trauma or animal bites were treated. 8 males and 15 females; aged 19 to 37 years, mean 27 years old. Total nasal defect in 4 cases, nose tip, columella and unilateral nasal defect in 6 cases, nasal tip, columella and bilateral nasal defect in 13 cases. Course of 2 to 24 years. In the first stage of operation, the frontal area of the skin was expanded. In the second stage, a trilobal pedicle pedicle pedicle pedicle screw pedicle was designed in the forehead. The size of the trocar was from 7 cm × 6 cm to 8 cm × 7 cm. cm × 0.8cm ~ 1.0cm × 1.0cm U-flap reconstruction of the nose. Eight of them underwent pedicle plastic surgery 6 months after total nasal reconstruction. Results All the flaps of 23 patients survived successfully and the incisions healed in the first stage. Supply for the first phase of healing. Patients were followed up for 9 to 45 months with an average of 19 months. Reconstruction nose appearance is good, similar color and adjacent tissue, nasal ventilation is good. Forehead for only the linear scar scar area. Conclusion Expanding the forehead pedicle flap full rhinoplasty is safe and reliable. It is an effective method for total nasal reconstruction.