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.
Objective To investigate the variation of supratrochlear vein and its relationship with supratrochlear artery and to provide anatomical basis for the reduction of congestive necrosis of paramedian forehead flap in the reconstruction of nasal defect. Methods Twenty sides of 10 antiseptic head specimens were anatomized macroscopically and microscopically. Using the horizontal and anterior median l ine of supraorbital rim as X and Y axis to locate supratrochlear vein and artery, the angles between the supratrochlear artery and vein and the supraorbital rim were detected, and the distances from the supratrochlear artery and vein to the anterior median l ine on the horizontal l ine of supraorbital rim were measured. Results The distance from the supratrochlear artery and supratrochlear vein to the anterior median l ine on thehorizontal l ine of the supraorbital rim was (16.2 ± 2.1) mm and (9.7 ± 3.1) mm, respectively, indicating there was a significant difference (P lt; 0.05). The angle between the supratrochlear vein and artery and the supraorbital rim was (83.3 ± 6.4)° and (80.5 ± 4.2)°, respectively, indicating there was no significant difference (P gt; 0.05). Two asymmetric supratrochlear veins were observed around the area of anterior median l ine in every specimen, one was far from the anterior median l ine (group A) and the other was close to or even on the l ine (group B). The distance from the supratrochlear veins to the anterior median l ine on the horizontal l ine of the supraorbital rim was (11.0 ± 1.9) mm in group A and (7.9 ± 3.2) mm in group B, showing there was a significant difference between two groups (P lt; 0.05). For all the specimens, the supratrochlear vein ran laterally along the medial anterior median l ine of the supratrochlear artery (one side was just on the anterior median l ine). The distance from the supratrochlear veins to the supratrochlear arteries on the horizontal l ine of the supraorbital rim was (6.6 ± 3.2) mm, (5.5 ± 2.0) mm in group A and (7.9 ± 3.9) mm in group B, indicating the difference between two groups was significant (P lt; 0.05). Conclusion The pedicle of the paramedian forehead flap should be wide enough (1.5-2.0 cm), the lateral boundary of the pedicle should be the supratrochlear artery while the medial boundary should be the supratrochlear vein.
The deltopectoral flaps were applied in 5 cases for whole nasal reconstruction. The follow-up period has lasted from 1 to 3 years and the results are satisfactory. This flap for whole nasal reconstuction provides abundant repair material. The operative procedure is simple, easy and the donor area is hide. The color and quality of the deltopectoral flap are good postoperation.
Eleven cases of partial nasal defect were reporte suc-cossfully repaired by transfer of various pedicled skin flaps.The external figure of the reconstructed noses was satisfacto-ry. The selection of various skin flaps were determined by thearca of the nasal defect.
ObjectiveTo explore the clinical application and effectiveness of a personalized tissue engineered cartilage with seed cells derived from ear or nasal septal cartilage and poly-glycolic acid (PGA)/poly-lactic acid (PLA) as scaffold in patients with nasal reconstruction. MethodsBetween March 2014 and October 2015, 4 cases of acquired nasal defects and 1 case of congenital nasal deformity were admitted. The patient with congenital nasal deformity was a 4-year-old boy, and the source of seed cells was nasal septal cartilage. The other 4 patients were 3 males and 1 female, aged 24-33 years, with an average of 28.5 years. They all had multiple nasal subunit defects caused by trauma and the source of seed cells was auricular cartilage. The tissue engineered cartilage framework was constructed in the shape of normal human nasal alar cartilage and L-shaped silicone prosthesis with seed cells from cartilage and PGA-PLA compound biodegradable scaffold. The boy underwent nasal deformity correction and silicone prosthesis implantation in the first stage, and the prosthesis was removed and implanted with tissue engineered cartilage in the second stage; the remaining 4 adult patients all used expanded forehead flaps for nasal reconstruction. All 5 patients underwent 1-4 nasal revisions. The implanted tissue engineered cartilage was observed during the operation and taken from 2 patients for histological examination.ResultsAll the incisions healed by first intention after the tissue engineered cartilage implantation, and the expanded forehead flaps survived. Postoperative low fever occurred in 3 patients. No complications such as infection, obvious immune rejection response, and tissue engineered cartilage protrusion were found in all patients. All patients were followed up 9-74 months (mean, 54.8 months). During follow-up, the patients had no obvious discomfort in the nose and the ventilation function were good. All patients were satisfied with the nasal contour. Early-stage histological examination showed the typical cartilage characteristics in 1 patient after the implantation of tissue engineered cartilage. Late-stage histological examination in 1 patient of tissue engineered cartilage showed the characteristics of fibrous connective tissue; and the other showed there was remaining cartilage.ConclusionThe safety of tissue engineered cartilage constructed in vitro for reconstruction is preliminarily confirmed, but the effectiveness still needs further verification.