宋振涛 张博 陈冬梅 张洪涛 易成刚

[摘要]目的：探讨应用额部扩张皮瓣复合耳软骨支架植入鼻再造术的效果。方法：对7例鼻缺损患者Ⅰ期行额部斜行扩张器埋置术，Ⅱ期行扩张皮瓣修复鼻尖、鼻翼及鼻小柱的同时，于残鼻内植入耳软骨支架，形成支撑结构。结果：7例术后均无感染，无软骨外露，再造鼻外观坚挺，色泽与邻近组织相似，形态逼真，效果满意。结论：额部扩张皮瓣复合耳软骨支架植入鼻再造术增加了鼻尖及鼻小柱的支撑、塑形，是较理想的鼻再造方法。

[关键词]额部扩张皮瓣；耳软骨；支架；鼻再造

[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2012）04-0564-02

Nose Reconstruction with the expanded forehead tissue flap combining with auricular cartilage stent

SONG Zhen-tao1,ZHANG Bo1,CHEN Dong-mei1,ZHANG Hong-tao1,YI Cheng-gang2

(1.Department of Plastic Surgery and Burns,Liaoning Provincial Corps Hospital,Chinese people's Armed Police Forces, Shenyang 110034,Liaoning,China；2.Institute of Plastic Surgery, Xijing Hospital,The Fourth Military Medical University)

Abstract:ObjectiveTo investigate the effect of nose reconstruction with the expanded forehead flap combining with auricular cartilage stent.MethodsThe 7 nasal defect patients were primarily operated tissue expansion with skin expanders placed obliquely under galea aponeuroticas of forehead.Secondly expanded forehead flaps were used to reconstruct nasal tips, nasal alas and nasal columellas,and meanwhile auricular cartilage frames were placed into deficient noses to forming the support structure.ResurtsIn 7 post-operative patients,with no infection,no cartilage exposure. The reconstructed nose which was straight, with similar color comparing with neighbouring tissue, had realistic form and satisfied effect.ConclusionNose reconstruction with the expanded forehead flap combining with auricular cartilage stent which enabled the nasal tip and nasal columella sustained and rearranged better is a desirable method.

Key words:expanded forehead tissue flap; auricular cartilage;stent; nose reconstruction

额部扩张皮瓣修复鼻部缺损，具有传统的额部皮瓣鼻再造的优点。色泽相似，血运丰富，易于塑形，且供区得以直接缝合而避免遗留皮片移植瘢痕，为现今鼻再造的首选方法。但临床中笔者发现，上述方法再造鼻存在着鼻尖不够挺拔，鼻小柱塌陷等缺点，故笔者采用耳软骨移植作为支架的方法增加鼻尖及鼻小柱的支撑塑形，并取得满意的手术效果。

1临床资料

本组患者7例，年龄16～41岁。鼻缺损原因：1例为狗咬伤，1例为人咬伤，1例为肿瘤感染，其余为外伤所致。术中于额部的额肌下埋置长方形扩张器1枚，其容量为150～200ml。Ⅱ期手术同时植入自体耳软骨作为支架，扩张额部皮瓣修复鼻尖、鼻翼及鼻小柱缺损。7例术后均无感染，无软骨外露，额部供瓣区瘢痕不明显，再造鼻外观坚挺，色泽与邻近组织相近，通气良好，形态逼真，效果满意。……