摘要
目的探讨个体化选择局部皮瓣Ⅰ期修复鼻翼部分缺损的可行性。方法回顾性分析2015年10月至2019年6月大连市中心医院38例鼻翼区肿物患者的临床资料,其中皮内痣5例,交界痣8例,基底细胞癌21例,毛发上皮瘤3例,鼻翼沟瘘管合并感染1例。采用局部麻醉为主的手术治疗,术中行冰冻病理学检查确诊并确定安全缘。所有患者均无鼻翼软骨浸润。鼻翼病灶切除后的缺损面积在1.0 cm×1.0 cm~3.0 cm×2.5 cm。根据鼻翼缺损的位置、大小,按照美学要求设计局部皮瓣,Ⅰ期修复术区缺损。其中,采用带蒂鼻唇沟皮瓣修复15例,改良菱形皮瓣修复10例,鼻唇沟旋转皮瓣修复6例,V-Y推进皮瓣修复5例,双叶皮瓣修复2例。结果1例术后因压迫包扎过紧导致血运障碍,1例术后感染,2例患者经对症处理后延期愈合;其余患者均愈合良好。所有皮瓣均成活,无面部畸形,美容效果良好。结论鼻翼部分缺损的Ⅰ期皮瓣修复,需要按照鼻面部的美学要求,因病而异,因医者经验而异,进行个体化皮瓣选择,达到兼顾修复缺损和美容的目的。
Objective To explore the possibility of repairing partial nasal alar defects with individualized design of localized skin flaps.Methods The clinical data of 38 patients with nasal alar region tumor from October 2015 to June 2019 in Dalian Municipal Central Hospital were retrospectively analyzed,including 5 cases with intradermal nevus,8 cases with junction nevus,21 cases with basal cell carcinoma,3 cases with trichoepithelioma,and 1 case with nasal alar sulcus fistula combined with infection.Surgical treatment with local anaesthesia was applied,and intraoperative freezing pathology was used to confirm the diagnosis and determine the safe margin.There was no nasal alar cartilage infiltration in all patients.The defect areas after resection of nasal alar lesions ranged from 1.0 cm×1.0 cm to 3.0 cm×2.5 cm.Local skin flap was aesthetically designed in accordance with the location and size of the nasal alar defect to primarily repair the defect.Among them,15 cases were repaired with pedicled nasolabial groove flap,10 cases with modified rhomboid flap,6 cases with rotatory nasolabial groove flap,5 cases with V-Y push flap,and 2 cases with double lobe flap.Results One case had blood transportation obstacle after operation caused by compression and bandaging,1 case had postoperative infection.Healing of the two cases delayed after treatment,and other patients healed properly.All the flaps survived without facial deformity,and the cosmetic effect was good.Conclusions The primary repair of the nasal alar defect needs to follow the aesthetic requirements of the nose and face,which varies with diseases and experience of doctors.Flap selection should be individualized to achieve both the purpose of repairing defects and beauty.
作者
佘翠平
林芳竹
马芙梅
刘得龙
仝屹峰
She Cuiping;Lin Fangzhu;Ma Fumei;Liu Delong;Tong Yifeng(Department of Otolaryngology,Dalian Municipal Central Hospital,Dalian 116033,China)
出处
《中国医师进修杂志》
2021年第5期416-420,共5页
Chinese Journal of Postgraduates of Medicine
关键词
鼻翼缺损
外科皮瓣
修复外科手术
回顾性研究
Nasal alar defects
Surgical flaps
Reconstructive surgical procedures
Retrospective studies
