利用鼻中隔粘骨膜复合瓣修复半侧鼻下部衬里缺损的临床研究(1)
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[摘要]目的：探讨一种半侧鼻下部全层缺损衬里修复的手术方法。方法：根据衬里缺损的面积，设计对侧相应大小鼻中隔粘膜软骨膜复合组织瓣，通过鼻中隔背部跨越鼻中隔软骨，将血运良好的复合组织瓣固定在缺损周边的骨膜上。对8例半侧鼻下部全层缺损患者采用此方法修复衬里，其中3例男性，5例女性，并同时运用局部皮瓣或额部皮瓣修复外层，耳软骨或肋软骨重建支架，随访6～12个月，了解鼻衬里恢复情况。结果：本组8例患者再造鼻衬里均血运良好，鼻腔大小及通气正常，鼻中隔形态正常，供区呼吸性上皮覆盖，无穿孔、感染或偏曲。结论：在半侧鼻下部全层缺损的衬里再造中，应用此方法进行衬里修复,组织性质最接近，血运好且薄，柔软且挛缩程度小，同时为软骨支架提供良好血供，保持了鼻部组织的完整及自然形态，是一种良好的鼻部衬里修复方式。
[关键词]鼻再造；鼻中隔；粘膜软骨复合组织瓣
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)02-0217-03
Restoring the nasal lining with the mucoperichondrial composite flap in unilateral full-thickness defects of the lower nose
SHAN Lei,HUANG Wen-bo,WU Qiong,ZHANG Chen-wei
(Department of Plastic and Reconstructive Surgery,Southern medical university,Zhujiang hospital,Guangzhou 510282,Guangdong,China)
Abstract: Objective To present a technique for nasal lining repair in unilateral full-thickness defects of the lower nose. Methods According to the lining of the defect area, we designed the corresponding size of contralateral septal mucoperichondrial composite flap, drew it through the incision of septal cartilage and secured it at the periosteum around the lining defect area. This method was applied in the lining repair of 8 cases, 3 male and 5 female after 6 to 12 months follow-up. The recovery outcomes were noted. Results This group of eight patients were in good vascular condition. The size of nasal cavity and nasal ventilation were normal. The septum strut was intact. The donor area of septum was recovered with respiratory epithelium. No perforation, infection or deviation occurred. Conclusions In the case of unilateral full-thickness defect of the lower nose, the lining repair method was more close to original loss tissue with good blood supply, less contraction degree, thinness and softness. It could provide good blood supply to the overlying cartilaginous framework, and maintain the nasal cavity in complete and natural form. We considered it as a good choice of the nasal lining reconstruction.
Key words：nasal reconstruction;nasal septum;mucoperichondrial flap
1920年鼻部整形医师Gillies曾指出[1]：对于有粘膜覆盖的腔隙应该重建其粘膜衬里。但事实上，很多医师仍未认识到鼻再造过程中其衬里修复的重要性。他们重建了鼻部外层皮肤的结构，不重视衬里修复，简单或不处理，遗留了一个粗糙，甚至裸露的鼻腔内面，任由其慢慢炎性愈合。结果是重建鼻外层皮瓣扭曲变形 ......
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