颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣修复鼻翼缺损(1)
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[摘要]目的:探讨颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣在修复鼻翼缺损中的应用。方法:根据反流轴型皮瓣原理,设计以颞浅动脉为供血的岛状耳廓复合组织瓣,经皮下隧道转移修复鼻翼缺损。结果:本组8例患者,7例全部成活,术后随访6～30个月,移植物的形态、色泽与正常鼻翼组织相似,效果良好。1例移植的岛状耳廓复合组织瓣表皮及部分软骨坏死。结论:颞浅动脉跨区供血的反流轴型岛状耳廓复合组织瓣修复鼻翼缺,是一种较为理想的修复方法。
[关键词]鼻翼缺损;耳廓复合组织瓣;反流轴型岛状皮瓣
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)08-1103-03
Repairing nasal ala defect with a reversal flow axial island auricular composite tissue flap based on the superficial temporal artery
LI Huan-cheng,CHEN Shi-hai
(Department of Cosmetic and Plastic Surgery,Second People's Hospital of Yulin,Yulin 537000,Guangxi,China)
Abstract:ObjectiveTo investigate the application ofreversal flow axial island auricular composite tissue flap based on the superficial temporal artery for alar ala defect.MethodsAccording to principles of reversal flow axial flap,we designed auricular composite island flap nourished by superficial temporal artery to repair nasal ala defect via a subcutaneous tunnel.ResultsAmong seven out of eight patients in this group the transplanted skin flap survived with 6 to 30 months' follow-up observation after operation, graft color and shape were very close to the ala nasal skin, with excellent results.One failed due to the transplanted auricular composite island flap skin and part of cartilage became necrotic after operation.ConclusionReversal flow axial island auricular composite tissue flap based on the superficial temporal artery is an ideal repairing method for nasal ala defect.
Key words:nasal ala defect;auricular composite tissue flap;reversal flow axial island flap
鼻翼缺损是整形美容外科较常见的畸形,由于鼻翼结构特殊,修复比较困难,常用的修复方法较多,各有优缺点[1]。笔者自2005年4月～2008年12月应用以颞浅动脉为供血的反流轴型岛状耳廓复合组织瓣修复鼻翼缺损8例,取得了比较满意的修复效果。
1临床资料
本组8例,男性6例,女性2例,年龄17～49岁,其中硫酸烧伤后缺损1例,被人咬伤后缺损2例,血管瘤激光治疗后缺损1例,肿瘤切除后缺损1例,鼻翼感染后缺损2例,车祸外伤后缺损1例。全部病例均为单侧鼻翼全层缺损,2例合并鼻头缺损、鼻小柱缩短畸形。移植的耳廓复合组织瓣面积最大2.3cm×2.0cm,最小2.0cm×1.5cm。
2手术方法
2.1 术前设计:术前用手触摸或应用多普勒血流仪检测颞浅动脉及耳后动脉并用美蓝作好标记;根据鼻翼缺损形状及大小于同侧耳廓上设计好需要切取的耳廓复合组织并用美蓝作好标记(图1A)。
2.2手术步骤
2.2.1 采用全麻或局麻,切口常规使用含有1/20万肾上腺素的肿胀液浸润麻醉。沿鼻翼缺损缘剖开,分离皮肤及鼻腔侧皮肤与黏膜组织,修整创缘,并将分离出的鼻翼软骨创缘切除约0.2cm,使之形成一沟槽,以便移植之耳软骨嵌入。
2.2.2 在耳廓上极沿颞浅动脉走向向顶部作长约8㎝的切口,在此切口远端作另一横切口,使切口呈“T”形,向两侧翻开头皮瓣,显露颞浅血管、耳后血管和两者之间的吻合区。
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