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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.

手术矫正杯状耳畸形的疗效观察

目的总结应用耳后舌状皮瓣联合软骨管对耳轮成形、耳甲腔软骨移植增大耳廓法治疗Ⅰ、Ⅱ型杯状耳畸形的疗效。 方法2011年3月－2014年3月，应用耳后舌状皮瓣联合软骨管对耳轮成形、耳甲腔软骨移植增大耳廓法治疗9例（10侧）Ⅰ、Ⅱ型杯状耳畸形患者。男8例，女1例；年龄6～20岁，平均10.1岁。双侧耳畸形1例、单侧8例。根据Tanzer（1975）分型标准：Ⅰ型1侧，Ⅱa 型4侧，Ⅱb型5侧。 结果术后切口均Ⅰ期愈合，无血肿、切口感染、皮瓣坏死等并发症发生。术后患者均获随访，随访时间3～12个月，平均9个月。术后耳廓无下垂，耳轮舒展，对耳轮走形自然，耳甲腔扩大，耳廓接近正常大小，双侧耳大致对称，形态良好，效果满意。 结论翻转耳后舌状皮瓣联合软骨管对耳轮成形、耳甲腔软骨移植法能有效矫正杯状耳解剖缺陷，是治疗Ⅰ、Ⅱ型杯状耳的有效方法。

单侧唇腭裂术后鼻翼基底部塌陷畸形矫正一例报告

目的总结1例单侧唇腭裂术后鼻翼基底部塌陷畸形矫正方法及疗效。 方法2011年3月，收治1 例单侧唇腭裂术后鼻翼基底部塌陷畸形17岁男性患者。鼻长轴偏向左侧 0.5 cm，鼻小柱高1.5 cm、偏向左侧。右侧鼻翼呈塌陷状，鼻翼外侧脚内陷。右侧上唇白唇处至鼻部基底见一纵形瘢痕。术中通过与健侧鼻翼软骨悬吊复位、采用白唇部瘢痕制作组织蒂固定于鼻翼基底部联合矫正畸形。 结果术后切口Ⅰ期愈合。术后6个月随访，患者两侧鼻翼基底部基本达水平，鼻尖偏斜矫正，创缘周围无坏死、复发。 结论利用白唇部瘢痕矫正手术操作简便，既切除了白唇部瘢痕组织，又解决了鼻翼基底部软组织量不足的问题，是矫正单侧唇腭裂术后鼻翼基底部塌陷畸形的有效方法之一。

带轴心血管的鼻唇沟皮瓣修复多个亚单位鼻缺损一例

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.

应用硅胶假体矫正复发性多软骨炎所致鞍鼻畸形一例

下唇 Abbe 皮瓣联合面颊部风筝推进皮瓣修复大面积上唇缺损

目的总结下唇 Abbe 皮瓣联合面颊部风筝推进皮瓣修复大面积上唇缺损的疗效及经验。方法2016 年 10 月—2018 年 10 月，收治 8 例大面积上唇缺损患者。男 5 例，女 3 例；年龄 7～69 岁，平均 35 岁。交通事故伤 4 例，犬咬伤 2 例，高处坠落伤 2 例。上唇部 2/3 缺损 6 例，1/2 缺损 2 例；皮肤肌肉缺损 5 例，全层组织缺损 3 例。受伤至入院时间为 20 min～4 h，平均 1.2 h。于上唇缺损区域同侧下唇设计带血管蒂的 Abbe 皮瓣，口周面颊部设计风筝推进皮瓣，联合修复上唇缺损。术后 3 周行二期断蒂修整术。结果术后皮瓣全部成活，创面均Ⅰ期愈合。4 例为进一步改善外观，分别接受唇部修整术及激光治疗。8 例均获随访，随访时间 1 个月～1 年，平均 3 个月。患者唇部外观及功能均良好，无明显瘢痕形成。结论下唇 Abbe 皮瓣联合面颊部风筝推进皮瓣修复大面积上唇缺损效果可靠。