管状鼻畸形

管状鼻是一种罕见的鼻部先天畸形。早在1884年,Selenkoff A.[1]曾用大量详细的篇幅报道过一名34岁患管状鼻农民的尸检情况。从此,他就以首次发表管状鼻的著作而赢得了广泛声誉。管状鼻是一种肉质棒状结构,在幼年时期大约长2～3 cm,直径1 cm(图1～3)。这一结构的中心是一小管道,其内层由成层的柱状上皮覆盖。在管状鼻的远端,管道的尽头形成一小的凹陷。管状鼻被认为是胚胎发育时期的软鼻。它的近端连接在内眦部,有时连接在外眦部,在极少数情况下连接于鼻根部中央或颏部。管状鼻通常是单发的,根据报道,只有1例是多发的。患管状鼻的一侧鼻往往…     

鼻唇沟皮下组织蒂皮瓣在鼻部缺损修复中的应用

目的 观察应用鼻唇沟皮下组织蒂皮瓣修复较大鼻部缺损的效果。方法 2017年6月—2022年2月,上海健康医学院附属嘉定区中心医院应用鼻唇沟皮下组织蒂皮瓣修复鼻部缺损24例。于缺损邻近部位设计鼻唇沟皮下组织蒂皮瓣,皮瓣大小根据缺损范围而定,按设计线切开皮肤,向下及周围潜行分离形成皮瓣,旋转修复鼻部缺损。结果 应用该方法修复鼻部缺损的24例患者均在局麻下完成,术中出血少,术后皮瓣成活良好,除2例出现远端部分表皮坏死外,其余均Ⅰ期愈合。术后术区美容效果佳,皮瓣质地、色泽与周围皮肤协调,瘢痕不明显,患者对面部修复的形态满意。结论 鼻唇沟皮下组织蒂皮瓣可较好地修复鼻部较大缺损,手术效果肯定,美学效果佳,是一种针对鼻翼及鼻背皮肤较大缺损较为理想的修复方法。     

皮下组织蒂鱼嘴状皮瓣修复鼻部基底细胞癌术后缺损

目的探讨鼻背和鼻侧壁基底细胞癌切除术后缺损应用鱼嘴状鼻唇沟皮下蒂皮瓣修复。方法根据鼻背和鼻侧壁缺损创面形状为长椭圆形的特点,我们设计了鱼嘴状鼻唇沟皮下蒂推进皮瓣进行修复。结果应用鱼嘴状皮下蒂皮瓣修复鼻背和鼻侧壁基底细胞癌患者6例,皮瓣全部成活,无并发症,外观满意,无眼鼻牵拉畸形。结论应用鱼嘴状鼻唇沟皮下蒂皮瓣修复鼻部缺损效果满意。     

尿道下裂一期修复术:应用双侧阴茎浅动脉腹外侧支皮瓣再造尿道

目的探索一种能有效防止术后尿道狭窄、尿瘘的一期尿道下裂修复技术。方法彻底矫直阴茎下弯畸形之后,即时在裂隙两侧缘形成2条适当宽度的阴茎浅动脉腹外侧支岛状筋膜皮瓣再造尿道。经隧道或剖开龟头,将尿道置于适当位置并开口于龟头远端。用阴囊中隔皮瓣旋转180°,覆盖阴茎腹侧创面,一次手术完成尿道下裂修复。结果修复阴茎阴囊型尿道下裂13例,再造的尿道及转移的阴囊皮瓣均100%成活,手术一次成功。随诊6个月～8年,13例均无尿道狭窄或尿瘘发生,阴茎完全挺直,排尿在龟头远端,尿路通畅成线。尿道吻合口处发生憩室1例。结论实施该技术的一期尿道下裂修复术,具有防瘘及成功率高之优点,可供临床医师选用。     

额部旋转皮瓣修复术治疗内眦基底细胞癌

我所自１９９６年以来,采用额部旋转皮瓣修复内眦基底细胞癌切除术后软组织缺损,取得医患双方均很满意的效果,报告如下： 临床资料　５例患者中男性２例,女性３例,病期８～１６个月,分别为结节溃疡型４例,色素型１例。年龄６３～８２岁,平均６９岁。５例基底细胞癌大小在０．４ｃｍ～０．８ｃｍｘ ０．７ ｃｍ～０．２ ｃｍ,肿瘤位置位于右眼内眦３例,左眼内眦２例。 皮瓣设计　局部常规消毒铺巾,在距肿瘤２～３ｍｍ处划切口线,在额部中央皱纹偏患侧计一尖端向上三角形皮瓣,中央皱纹处为蒂部,另一边和切口线相连。根据欲切除…     

应用额鼻皮瓣修复鼻部缺损

整形外科起源于鼻整形,鼻位于面部正中,对面部的轮廓和容貌起着极为重要的作用[1].鼻部尤其是鼻尖鼻背部皮肤肿瘤占面部皮肤肿瘤的比例很大,如何修复鼻部皮肤肿瘤切除术后缺损,日益成为临床医师常见及比较棘手的问题.我科自2009年1月开始,遵循鼻亚单位的美学原则,应用额鼻皮瓣法修复鼻部皮肤肿瘤术后缺损30例,均获得满意的功能和美学效果.为在临床大规模开展和进一步探索改进,提供了坚实的技术支持.     

局部皮瓣在鼻部皮肤肿瘤切除后创面修复中的应用

【摘要】 目的 探讨局部皮瓣在鼻部皮肤肿瘤切除后创面修复中的效果。方法 2015年3月至2016年8月于新疆维吾尔自治区人民医院皮肤科纳入65例鼻部皮肤肿瘤患者,手术切除鼻部肿瘤,根据鼻缺损的部位、大小、形状以及周围皮肤情况等选择鼻唇沟皮瓣、改良菱形皮瓣、双叶皮瓣或额鼻皮瓣等修复皮肤软组织缺损。结果 65例患者中,基底细胞癌38例,色素痣20例,角化棘皮瘤5例,鳞状细胞癌2例。切除后缺损长径均未超过2.5 cm,32例用鼻唇沟皮瓣修复缺损,16例用改良菱形皮瓣,12例用双叶皮瓣,5例用额鼻皮瓣,术后皮瓣全部成活,未见鼻部明显变形,随访1年未见复发。结论 对于鼻部皮肤肿瘤切除后长径未超过2.5 cm的皮肤缺损,用鼻唇沟皮瓣、改良菱形皮瓣、双叶皮瓣、额鼻皮瓣等修复可以获得较满意的效果。     

额部扩张皮瓣修复肿瘤治疗后的下睑外翻畸形17例临床分析

目的观察以滑车上血管及眶上血管为蒂的额部扩张皮瓣带蒂转移修复肿瘤治疗后下睑外翻畸形的临床效果。方法选取2010年7月-2019年9月,本科收治的17例眶下区肿瘤治疗后下睑外翻畸形患者,一期:在额部滑车上血管及眶上血管供区置入皮肤软组织扩张器,予以充分扩张;二期:切除眶下区病损组织,松解周围组织使下睑恢复至正常解剖形态,再将额部扩张皮瓣带蒂转移修复病损切除后的创面;三期:3周后皮瓣予以断蒂,修复二期遗留病损切除后的创面。结果 17例患者均未发生皮瓣淤血、坏死,修复后下睑形态良好,外翻畸形矫正,眼睑闭合完全,活动自如。术后随访6～12个月,下睑外翻均无复发。结论以滑车上及眶上血管为蒂的额部扩张皮瓣带蒂转移,是修复肿瘤治疗后下睑外翻畸形的一种较为有效的方法。     

遵循鼻亚单位美学原则的鼻部基底细胞癌手术治疗

目的探索鼻部基底细胞癌手术切除后的整形修复方法。方法在遵循鼻亚单位组成的美学原则基础上,根据鼻部创面的大小、形状、深度,设计皮瓣覆盖创面。结果共施行手术21例,创面面积1．2cm×1．2cm-4．0cm×6．0cm。术后皮瓣全部成活,无明显并发症发生。其中18例获得随访l～36个月,鼻外形轮廓较好,修复组织与周围皮肤匹配良好。结论基底细胞癌恶性程度较低,发展缓慢,可在遵循鼻亚单位关学原则基础上,应用皮瓣修复鼻部创面。此法既能治愈癌症,又能满足患者的生理及心理需求,提高患者生活质量。     

保留甲床的指脱套伤修复术

目的报道一种保留甲床的指脱套伤的修复方法。方法2000年2月～2004年6月,应用腹部带蒂真皮下血管网皮管修复指脱套伤同时保留甲床8例。8例均为机器绞拉引起的撕脱伤,伤后1～5小时急诊手术,于下腹部切取皮瓣后将远端2/3处修薄,皮下脂肪保留2～4mm,然后制成皮管状,将伤指套入缝合创缘。结果术后8例皮管全部成活。随访5～18个月,皮管质地柔软、平整,断蒂后不需要再修整,保留甲床的指甲生长正常,伤指外形接近正常指,功能恢复满意。结论应用腹部带蒂真皮下血管网皮管修复指脱套伤,疗程短,可保留指末节及甲床,术后外形及功能恢复佳,是一种修复较理想的方法。     

Island pedicle flaps for medial canthus repair

Background The medial canthus is a frequent site for skin cancer and reconstruction after Mohs surgery can prove to be challenging. In the literature various reconstruction methods are recommended for these cases. Flap reconstructions are mostly transposition flaps from the glabella, skin with different properties from that in the canthal region, hence mostly requiring correction in a second stage. Objectives To ascertain the utility of a different reconstruction method, applying island pedicle flaps for medial canthal lesions and obviating the necessity for second‐stage corrections. Methods A review was undertaken of the medical records and photographs of patients who had a pedicle island flap reconstruction for medial canthal defects after Mohs surgery. There were four different possibilities: a pedicle island flap from the cheek, the back of the nose or the glabella or a combination of these flaps. Results Sixteen patients were reconstructed by pedicle island flaps for defects of the medial canthal area. A follow‐up for all patients after 1 year indicated that all patients showed good to excellent results. No cases of web deformation and ectropion were found. Conclusions This flap is not mentioned in textbooks in reference to the reconstruction of canthal lesions and its value for this particular location is probably underestimated.     

男-女易性癖外科治疗中具有性感觉功能的阴蒂再造

目的研究一种新的阴蒂再造的方法同时使再造的阴蒂具有良好的形态和性感觉功能。方法以阴茎背血管、神经为蒂的岛状部分龟头组织瓣再造阴蒂。结果自1991年始临床用此方法再造的58例阴蒂既有形态又有良好的性感觉功能。结论在男-女易性整形手术中,以阴茎背血管、神经为蒂的岛状龟头组织瓣再造阴蒂是一种全新的完全可靠的方法。     

肉芽肿性口周皮炎一例

患者男,35岁,5个月前面部出现红斑及丘疹,逐渐增多,病前曾外用丙酸氯倍他索霜等糖皮质激素。皮损为直径1～3mm大的淡红色坚实小丘疹,主要分布于眶内侧、鼻周及口周等处。病理检查显示,真皮毛囊皮脂腺周围有上皮细胞肉芽肿病变。明确诊断后停用糖皮质激素,局部对症处理,半年后皮损消退。     

Interpolation flaps

Interpolation flaps provide an excellent method for reconstruction of large or deep defects where adjacent local tissue cannot supply sufficient donor tissue for repair. These flaps use tissue imported from nonadjacent sites with an inherent blood supply (vascular pedicle) to support the flap while attached to the recipient defect until neovascularization has been ensured between the flap and recipient bed. Hence, they can supply the thickness or bulk needed for large or deep defects and can survive on exposed bone or cartilage. The main disadvantage of these flaps is that they require two stages to complete because the delayed second stage releases the pedicle after inosculation and neovascularization render the tissue independent of the pedicle. This article describes three major interpolation flaps useful in repair of the nose and ear. The forehead, melolabial, and postauricular interpolation flaps are excellent methods that will add to the dermatologic surgeon's reconstructive armamentarium for the repair of large or deep defects.     

The nasolabial flap as a single-stage procedure

The nasolabial flap is a useful reconstructive technique for the repair of defects on the nose. An improved technique used in 32 patients is presented, which allows use of this procedure as a single-stage rather than the more commonly seen two-stage procedure. The alterations include the following: (1) the excision of a Burow's triangle superior edge of the defect toward the inner canthus; (2) the use of a periosteal or suspension suture to minimize tenting across the concave junction of the nose and cheek; (3) wide undermining of the skin surrounding the defect to create a stabilizing platelike scar; (4) significant thinning of the donor flap; and (5) adjust the size of the flap to recreate the original preincisional skin tension on the flap after suturing. None of the 32 patients presented required a second-stage procedure to correct trapdoor defects or to recreate natural folds or creases.     

应用局部皮瓣修复内眦皮肤缺损15例

目的 报道局部皮瓣修复皮肤肿瘤切除后的缺损的经验与体会.方法 使用局部皮瓣修复内眦部皮肤缺损15例,创面面积约1 cm×1 cm～1.8 cm × 2.0 cm.根据创面的位置及大小,分别选择眉间皮瓣、旋转皮瓣、推进皮瓣、鼻唇沟皮瓣或联合使用两种局部皮瓣等方法进行修复.结果 15例中12例使用单一皮瓣修复创面,3例使用两个局部皮瓣联合修复创面,共使用18个局部皮瓣,术后皮瓣全部成活,切口Ⅰ期愈合.术后随访11例6个月至1年,皮瓣与周围皮肤组织的色泽、质地相近,切口瘢痕隐蔽,未发生内眦部及附近组织器官明显畸形,形态满意,功能良好.结论 修复内眦部皮肤缺损时,如果能选取合适的局部皮瓣,并注意保持和恢复内眦美容单位的完整性,将取得良好的形态与功能效果.

Abstract：

Objective To reconstruct skin defects with local flaps after resection of tumors. Methods From October 2006 to December 2009, medial canthal defects in 15 patients were repaired with local flaps in the hospital. The size of the defects varied from 1 cm × 1 cm to 1.8 cm × 2.0 cm. According to the size and location of the defects, different local flaps such as glabellar flaps ,rotation flaps, advancement flaps, nasolabial flaps and combination of these local flaps were selected and designed to repair the skin defects. Results Of the 15 patients, 12 received the reconstruction of skin defects with single flap, the other 3 with two flaps; totally,18 local flaps were designed and applied. All the flaps survived with primary healing postoperatively. A followup in 11 patients for 6 to 12 months showed that the color and texture of flaps were similar to those of surrounding tissues and incision line scar was inconspicuous. Medial canthal contours were restored without distortion of surrounding structures. Satisfactory function and aesthetic outcomes were achieved. Conclusions In the repair of inner canthus skin defects, to maintain and restore the "cosmetic unit" integrity of inner canthus by using suitable local flaps would lead to a satisfying restoration of function and appearance.     

鼻翼软骨肌肉环的修复在唇裂鼻畸形中的作用

目的分析唇裂鼻畸形发生的病理解剖学基础,探索更加符合解剖特点的唇裂鼻畸形矫正方法。方法对30具成人尸体、1具单侧唇裂胎儿标本行大体解剖,并结合临床102例唇裂鼻畸形患者的术中所见,进行比较解剖研究。结果正常人外鼻下端存在由鼻肌翼部、鼻肌中隔部与鼻翼软骨形成的环状结构,而唇裂患者的这个环状结构发育不良。据此设计了旨在修复鼻翼软骨环的手术方法,临床应用102例,效果良好。结论鼻翼软骨肌肉环是外鼻下端重要的解剖结构。唇裂患者因鼻翼软骨肌肉环发育不良,进而导致了鼻部肌力的失衡。因此,唇裂鼻畸形矫正中修复鼻翼软骨环状结构具有重要意义。