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RECONSTRUCTION OF LARGE NASAL DEFECTS WITH LATERAL NASAL ARTERY PEDICLED NASOLABIAL FLAP

Objective To evaluate the curative effect of the lateral nasal artery pedicled nasolabial flap for reconstruction of nasal defects. Methods From August 2005 to March 2009, 12 cases of large nasal tip and alar defects were repaired with the lateral nasal artery pedicled nasolabial flap. There were 5 male patients and 7 female patients with a mean ageof 48.6 years (range, 35-60 years). Five cases of nasal defects were caused by trauma and other defects were caused by excision of carcinoma or hemangioma; the courses of disease were 1 to 10 years and 3 months to 40 years, respectively. The nasal defect size ranged from 2.0 cm × 1.5 cm to 4.5 cm × 2.5 cm. All defects were reconstructed with lateral nasal artery pedicled nasolabial flap in 9 cases and with island flap in 3 cases. The flap size ranged from 2.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. Five patients required cartilage grafts for alar rim support and the distal end of the nasolabial flap was thinned and folded to repair the nasal l ining. The donor sites were sutured directly. Results The mild venous stasis at the distal end of three island flaps occurred at 5-24 hours postoperatively and alleviated spontaneously. All flaps survived. Incision at donor and accepted sites healed by first intention. Flap revision was performed in 5 cases after 6-15 months because of mild swell ing at the pedicles of skin flaps. All patients were followed up 8-24 months, with an average of 13 months. All patients achieved satisfactory results in nasal appearance, flap texture and color, and ventilatory function. No obvious scar was found at donor sites. Conclusion The nasolabial flap is an excellent choice for reconstruction of defects of nasal tip and ala.

帶軸心血管的鼻唇溝皮瓣修復多個亞單位鼻缺損一例

下唇 Abbe 皮瓣聯合面頰部風箏推進皮瓣修復大面積上唇缺損

目的總結下唇 Abbe 皮瓣聯合面頰部風箏推進皮瓣修復大面積上唇缺損的療效及經驗。方法2016 年 10 月—2018 年 10 月，收治 8 例大面積上唇缺損患者。男 5 例，女 3 例；年齡 7～69 歲，平均 35 歲。交通事故傷 4 例，犬咬傷 2 例，高處墜落傷 2 例。上唇部 2/3 缺損 6 例，1/2 缺損 2 例；皮膚肌肉缺損 5 例，全層組織缺損 3 例。受傷至入院時間為 20 min～4 h，平均 1.2 h。于上唇缺損區域同側下唇設計帶血管蒂的 Abbe 皮瓣，口周面頰部設計風箏推進皮瓣，聯合修復上唇缺損。術后 3 周行二期斷蒂修整術。結果術后皮瓣全部成活，創面均Ⅰ期愈合。4 例為進一步改善外觀，分別接受唇部修整術及激光治療。8 例均獲隨訪，隨訪時間 1 個月～1 年，平均 3 個月。患者唇部外觀及功能均良好，無明顯瘢痕形成。結論下唇 Abbe 皮瓣聯合面頰部風箏推進皮瓣修復大面積上唇缺損效果可靠。

Application of thin-ribbed cartilage with the perichondrium in correction of secondary cleft lip nasal deformity as lateral crural onlay graft

ObjectiveTo explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft.MethodsA retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured.ResultsAll incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no compli cation, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest points of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral points of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation (P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril’s outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line (P<0.05). No thoracic contour change occurred at the costal cartilage donor site.ConclusionThe thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.

應用硅膠假體矯正復發性多軟骨炎所致鞍鼻畸形一例

單側唇腭裂術后鼻翼基底部塌陷畸形矯正一例報告

目的總結1例單側唇腭裂術后鼻翼基底部塌陷畸形矯正方法及療效。 方法2011年3月，收治1 例單側唇腭裂術后鼻翼基底部塌陷畸形17歲男性患者。鼻長軸偏向左側 0.5 cm，鼻小柱高1.5 cm、偏向左側。右側鼻翼呈塌陷狀，鼻翼外側腳內陷。右側上唇白唇處至鼻部基底見一縱形瘢痕。術中通過與健側鼻翼軟骨懸吊復位、采用白唇部瘢痕制作組織蒂固定于鼻翼基底部聯合矯正畸形。 結果術后切口Ⅰ期愈合。術后6個月隨訪，患者兩側鼻翼基底部基本達水平，鼻尖偏斜矯正，創緣周圍無壞死、復發。 結論利用白唇部瘢痕矯正手術操作簡便，既切除了白唇部瘢痕組織，又解決了鼻翼基底部軟組織量不足的問題，是矯正單側唇腭裂術后鼻翼基底部塌陷畸形的有效方法之一。

手術矯正杯狀耳畸形的療效觀察

目的總結應用耳后舌狀皮瓣聯合軟骨管對耳輪成形、耳甲腔軟骨移植增大耳廓法治療Ⅰ、Ⅱ型杯狀耳畸形的療效。 方法2011年3月－2014年3月，應用耳后舌狀皮瓣聯合軟骨管對耳輪成形、耳甲腔軟骨移植增大耳廓法治療9例（10側）Ⅰ、Ⅱ型杯狀耳畸形患者。男8例，女1例；年齡6～20歲，平均10.1歲。雙側耳畸形1例、單側8例。根據Tanzer（1975）分型標準：Ⅰ型1側，Ⅱa 型4側，Ⅱb型5側。 結果術后切口均Ⅰ期愈合，無血腫、切口感染、皮瓣壞死等并發癥發生。術后患者均獲隨訪，隨訪時間3～12個月，平均9個月。術后耳廓無下垂，耳輪舒展，對耳輪走形自然，耳甲腔擴大，耳廓接近正常大小，雙側耳大致對稱，形態良好，效果滿意。 結論翻轉耳后舌狀皮瓣聯合軟骨管對耳輪成形、耳甲腔軟骨移植法能有效矯正杯狀耳解剖缺陷，是治療Ⅰ、Ⅱ型杯狀耳的有效方法。