用横形叉状皮瓣重建鼻小柱

鼻小柱的肿瘤切除术后的修复方法很多,最理想的手术方法是采用邻近组织皮瓣一期修复缺损。本文通过两个病例描述了横形叉状皮瓣重建鼻小柱的治疗方法。例1,女性,69岁,鼻小柱基底细胞癌切除后,用双侧蒂在中央的横形上唇皮瓣修复鼻小柱。皮瓣抬起后转移至鼻小柱区,两侧皮瓣并排后缝合。供区直接拉拢缝合后仅有轻微变形,术后9个月已不明显(图1)。例2,男性,79岁,患鼻小柱基底细胞癌,肿瘤切除后的缺损用一个单侧的蒂在中央的横形上唇皮瓣来修复。皮瓣向远处延伸尽可能覆盖一些鼻尖。术后6     

应用游离耳轮软骨皮瓣修复鼻尖、鼻小柱和(或)鼻翼缺损

以往修复鼻翼、鼻尖和(或)鼻小柱的部分或全部缺损的方法,具有多期手术、皮瓣臃肿和遗留面部瘢痕等缺点。作者报告5例鼻尖、鼻小柱和鼻翼部分或全部缺失患者采用以颞浅血管耳前支为蒂的游离耳轮软骨皮瓣(chondrocutaneous ear helical free flap)进行整复,取得良好效果。 血管蒂解剖 颞浅动脉系颈外动脉的较小终末     

上唇鼻正中裂合并鼻小柱纤维瘤改良手术一例

上唇鼻正中裂合并鼻小柱纤维瘤改良手术一例邱文生范平姚军波张庆诗姚顺昌我们收治１例上唇鼻正中裂合并鼻小柱纤维瘤患者，采用上唇鼻正中裂改良手术方法并鼻小柱纤维瘤切除一次整复成功，现报道如下。患者男，２２岁。自幼上唇正中有一裂隙，鼻尖低平，鼻前长一球形肿物...     

鼻睑部软组织缺损的额瓣一期修复

目的:探讨鼻呤部软组织缺损的额部岛状皮瓣修复方法.方法:对8例鼻睑部软组织缺损患者,采用显微外科微创分离技术制备单侧额部岛状皮瓣进行一期修复,并将局域皮瓣翻转再造眼睑,完成鼻睑重建,供瓣区从下腹部取皮片游离移植修复或直接拉拢缝合.皮瓣设计面积最小2.5 cm×3 cm,最大8 cm×5 cm.结果:8例患者转移皮瓣均完伞成活,鼻睑外形和表情功能恢复良好,眼睑功能明显改善.结论:额部岛状皮瓣质地、颜色与受区近似并相邻,可最大程度恢复而部的美学亚单位结构,是修复鼻睑软组织缺损的一种理想材料.     

全前脑无裂上唇正中裂及鼻小柱缺失修复一例病例报告

全前脑无裂,上唇正中裂比较少见,鼻尖凹陷、鼻小柱缺失较重症者更为少见,如何一次手术修复重症上唇正中裂鼻畸形而达到比较理想的效果非常困难。我们采取利用受术者鼻中隔软骨部分前移为支架、一次完成修复上唇正中裂、鼻小柱缺失、鼻尖凹陷畸形手术一例。报告如下。     

应用"L"型硅胶假体与膨体聚四氟乙烯补片修复单侧唇裂鼻畸形17例报道

目的:探讨应用“L”型硅胶假体与膨体聚四氟乙烯(ePTFE)补片修复单侧唇裂鼻畸形的方法及效果。方法:在纠正错位软骨的基础上,在“L”型硅胶假体上的鼻尖部附加一(ePTFE)薄片,用5-0尼龙线将两者缝合固定,对单侧唇裂鼻畸形患者进行鼻背、鼻尖、鼻翼、鼻小柱的加固和塑形。结果:“L”型硅胶假体与(ePTFE)补片联用,可使扁平的鼻梁、鼻尖及塌陷的鼻翼抬起,使鼻小柱挺立,大大改善了鼻的外观,效果满意,优良11例,改善6例。结论:应用“L”型硅胶假体与ePTFE修复单侧唇裂鼻畸形,是一种简便有效的方法。     

应用耳甲修复耳廓的其他部位

耳廓由二部分组成:耳甲和其余部分,在以前(Orticochea 1971)鼻的修复中,作者发现即使整个耳甲被切除而以皮瓣修复时,耳朵看来没有特别的畸形。美容主要是靠耳廓的其余部分。作者过去报告过一个用耳甲瓣修复鼻小柱和鼻翼缺损的病例。耳甲瓣多方面的用途能使很不相同的耳缺损得到修复。例2、在图8手术图解中(a)连同无毛     

鼻的侧面大型缺损的初期一次修复

大多数整形外科医生感到:为了避免丑陋畸形长时间存在,当肿瘤连同周缘正常组织已被完整切除时,初期的一次修复是需要的。颊部、鼻唇部或额部的皮瓣常被用于修复鼻的侧面的缺损。如果是一个穿透性缺损,那么被选用的手术方法应提供皮肤衬里和被盖,特别是在鼻翼部。对于这种修复,一个褶叠的鼻唇部旋转皮瓣就提供了即时封闭。然而,对于修复大型的侧方缺损,单一的鼻唇皮瓣产生的外貌,在我们的病例中是不满意的。因为这个缘故,在修复大的缺损时,我们现在把这个手术方法同一个眉间皮瓣结     

前唇星状瓣与改良Abbe氏瓣联合应用修复双侧唇裂术后严重鼻唇畸形

目的 修复双侧唇裂术后严重鼻唇畸形。方法 将前唇星状瓣与下唇改良Abbe氏瓣联合应用修复双侧唇裂术后严重鼻唇畸形。结果 本组病例共23例,均取得了较好的治疗效果。结论 此法对双侧唇裂术后继发鼻小柱短小、鼻尖扁平、鼻唇角不显、唇珠缺失、上唇过紧和过薄畸形均有较好的治疗效果。     

局部组织瓣整复鼻缺损的临床经验

目的:探索修复鼻翼缺损简单易行、形态效果佳的治疗方法。方法:自1995年以来共收治30例鼻缺损患者,其中额部中央皮瓣3例,以一侧滑车上血管蒂经鼻根皮下隧道穿行到鼻部缺损区;鼻唇沟组织瓣者17例19侧,均设计蒂在上的组织瓣;耳廓全厚三明治式游离瓣10例11侧。结果:额部中央皮瓣3例,鼻唇沟组织瓣17例全部成活;耳廓全厚三明治式游离瓣10例,其中1例首次移植坏死,第2次手术成功。结论:扩张增容后的中央额瓣是全鼻缺损再造的首选治疗方案;整复鼻翼、鼻尖缺损,单侧鼻唇沟皮瓣长度在4～5cm,宽度在1.2～1.5cm为佳。耳廓全厚三明治式游离瓣,宽度在1.8cm以内较安全。     

双侧唇裂术后鼻唇畸形的修复

目的 报道双侧唇裂术后鼻唇畸形修复的一种新方法。方法 在双侧鼻孔的内侧沿鼻小柱皮肤粘膜交界缘向下达鼻小柱基部并经鼻底向外达外侧脚外侧并绕鼻翼外侧脚弧形向上;在上唇正中上部画出叉形瓣切口线;再在双侧鼻孔底部上唇瘤痕两侧画垂线至唇红缘。然后切开鼻底及鼻翼外侧脚皮肤,在鼻翼内侧脚上端缝合。将叉形瓣向上推形成鼻小柱下端。切除上唇瘢痕组织,必要时可设 Abbe瓣经旋转180°后按粘膜、肌层及皮肤层缝合。10～14天行Abbe瓣断蒂。结果 用该术式对34位患者进行了手术,术后鼻唇外形、鼻小柱长度及鼻孔大小趋于正常。上唇过紧得到了松驰。结论 该术式对双侧唇裂术后鼻唇畸形矫正有用。     

Defects of nasal septum skin part elimination

Method of elimination of nasal septum skin part defects was offered with creation of full-fledged receptive bed in the defect and cicatricially changed nose tip region with subsequent columella plastic by skin flaps from the region of the bases of nasal wings and upper third of the upper lip. The method allows to fill the defect of nasal septum skin part, to eliminate cicatricial deformity of nose tip, to shift wing of nose curls in right position, to reduce the lower third face height; hence the face becomes more harmonious.     

A new modified forked flap with subcutaneous pedicles for adult cases of bilateral cleft lip nasal deformity: from normalization to aesthetic improvement

In adult cases of bilateral cleft lip nasal deformity, an esthetically satisfying result can not be obtained only by manipulation inside the nose with the nasal tip pointing upward. The nasal tip should be made in a more anterior direction for nasal esthetic improvement. Additional tissue beyond the nose is needed, and the forked flap is a useful method in such cases. However, the blood circulation of long and narrow flaps containing the scar, especially after open rhinoplasty, is unstable. We have developed a new long and narrow forked flap that has a more stable blood circulation. The forked flap was made using two subcutaneous pedicles attached to the periphery of the each flap. We applied this flap to five adult cases of bilateral cleft lip nasal deformity. Four of the cases had the scar associated with the flying bird incision, and one case required no treatment after the primary repair. All the flaps took without signs of partial necrosis. In all cases, the nasal tip was projected forward with adequate columella elongation, and the profile was esthetically improved. In the final stage of correction for adult cases of bilateral cleft lip nasal deformity, this method, making maximum use of the tissue containing the scar in not only the white lip but also the vermilion, is very effective. It is very important to obtain nasal esthetic improvement for the adult patient with bilateral cleft lip nasal deformity.     

Reconstruction necessitated by severe hypoplasia or a columella defect

In reconstruction necessitated by severe hypoplasia or a columella defect, the surgeon must consider various factors in each case, such as the characteristic columellar shape, color match, texture, patient age, original disease, and surrounding scars. In these cases, reconstruction of both the cartilaginous strut and the overlying skin is necessary and important to obtain good results. The authors report three cases of reconstruction of the columella with satisfactory results. Case 1 involved a 6-year-old girl with complete bilateral cleft lip and severe hypoplasia of the premaxilla and prolabium. Columellar reconstruction was performed with small triangular flaps at the columella base, together with a rib chondral graft for cartilaginous support. Case 2 involved a 12-year-old girl with a complete bilateral cleft lip and cleft palate. Columellar reconstruction was performed with small triangular flaps at the columella base, together with bilateral conchal cartilage grafts. Case 3 involved a 17-year-old boy with a right complete cleft lip and columellar defect caused by previous infection after secondary cheiloplasty. Columellar reconstruction was performed using a left nasal vestibular flap and septal cartilage grafting, together with a bilateral conchal cartilage graft beneath the flap. The authors consider the unilateral nasal vestibular flap to be very useful in carefully selected unilateral cleft cases.     

Surgical treatment methods for the short saddle nose and high skin portion of the upper lip

Remote results of treatment are analyzed in 10 patients with deformations of the nose combining a shortened nose and pulled in skin of the septum. The patients were operated on according to Burian. Good results were obtained in 4 cases, satisfactory in 5. A higher share of satisfactory results of Burian's operation is explained by the fact that it is very difficult to draw down the thick porous skin into a proper position, particularly at the tip of the nose. Additional operations are needed, deteriorating the cosmetic effect. The method proposed by the authors yields better results: 89% good and 16% satisfactory. The intervention is aimed directly at removal of the deformation and tissue defect. Mutual transposition of three flaps, one of which is a drawn columella and two other flaps from the upper lip fill the mucosal defect, repairs the pulled in skin part of the septum and elongates the tip of the nose. In addition, transposition of skin flaps from the upper third of the upper lip to the site of mucosal defect shortens the height of the upper lip, thus creating a correct proportion of the middle and lower thirds of the face.     

Improved nasal tip projection in the treatment of bilateral cleft nasal deformity

The cleft nose deformity in bilateral cleft lip and palate patients with severely flattened alar cartilages, a short, scarred columella, and thickened skin is a reconstructive challenge. The Wolfe double-arch tip rhinoplasty technique was compared with a cartilage release and tip grafting technique to determine the optimal modality for tip projection and columella lengthening. Patients with significant bilateral cleft nasal deformities and previous bilateral cleft lip repairs were divided into two groups (n = 22). Group 1 (double-arch) patients underwent an open rhinoplasty using conchal cartilage grafts to create a columellar strut and new lower lateral arches placed over the existing arches (n = 12). In group 2 (release and tip graft), the lower lateral cartilages were released, and nasal tip grafting was performed (n = 10). Preoperative and 6-month postoperative measurements, including (1) columellar length, (2) alar base-nasal tip-columellar base (ATC) angle, and (3) lateral tip projection, were compared. The lateral tip projection is the perpendicular distance between the nasal tip and a line created from the connection of points at the nasion to the subnasale. In group 1 (double arch), the mean columella length increased 47.2%, whereas in group 2 (release and tip graft), it only increased 14.1%. The ATC angle had a mean decrease or narrowing of 26.7 degrees in group 1, compared with a 12.5 degrees decrease in group 2. Lateral tip projection improvement was greater in group 1 (52.2% increase) compared with group 2 (19.9% increase). The authors' data showed that for the difficult bilateral cleft nasal deformity with significant tip flattening, the double-arch tip rhinoplasty provides improved nasal tip projection.     

Construction of the congenitally missing columella in midline clefts.

BACKGROUND: Repair of the rare median cleft lip occurring with agenesis of the columella is a challenge as there is a major deficiency of skin and underlying structures. MATERIAL AND METHODS: Over a 23- year period, five children underwent construction of a columella. A new surgical technique was designed for this: an internal dorsal nasal flap was used to create a cutaneous-cartilaginous flap inside the nasal dome, and was then sutured inferiorly against a superior triangle of the repaired median cleft lip. RESULTS: Projective nasal growth could be seen in three of the five surgically constructed columellae in whom the medium-term results could be evaluated. CONCLUSION: Five holoprosencephaly cases, all with a median cleft lip and agenesis of the columella, underwent a median cleft lip repair and the creation of a columella by means of an internal nasal dorsal skin flap procedure.     

The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.     

Scar flap for extension of the nasal and lip soft tissue shell in secondary cleft deformities: final aesthetic touches in clefts-part iii

A scar flap is formed with the pedicle at the lateral part of the columella base at the cleft side, that is, in the center of the affected region. It enables flap placement according to individual need. A prospective evaluation was performed in a group of 76 patients with cleft lip and palate, all operated on by the same plastic surgeon. The flap was used to improve the height of the columella and the extent of nasal mucosa on the frontal septum and on the nostril base in the vestibule. In the lip, the flap raised its height and improved proportionality. The average area of flap used in a unilateral deformity was 42 mm. Both flaps in a bilateral deformity were 77 mm. The average follow-up was 22.4 months. Neither local nor general complications were noted apart from a recurrence of the deformity of the nasal septum in 7.9% of patients. The nasal passage was improved in 59.9% of patients and normalized in 19.6% upon follow-up rhinomanometry, but nevertheless, only one third of patients overcame their dynamic stereotype of breathing by the mouth. Anthropometric measurements showed an absence of statistically significant differences between patients after surgery and healthy individuals in crucial parameters (nasal tip projection, length of columella, nasolabial angle, nasal angle, and lip angle). The loss of the stigmatizing deformity is based on rotation of the nasolabial angle in relation to the aesthetic axis of the face. Direct examination proved aesthetic and functional improvement as statistically significant in 92.1% of patients.     

Repair of bilateral complete cleft lip and nasal deformity--state of the art.

OBJECTIVE: Dissatisfaction with the stigmata of repaired bilateral cleft lip has stimulated surgeons to change conventional operative strategies. The old staged labial repairs, one side and later the other, have been replaced by simultaneous closure. For nasal correction, most surgeons no longer believe that the columella is deficient, and thus there is no need to recruit tissue from the lip or nostril sills as a secondary procedure. The columella is concealed in the nose. The new strategy is to construct the columella and nasal tip by anatomic positioning of the alar cartilages and sculpting the investing skin. Furthermore, nasal correction is done at the time of bilateral labial repair and, whenever possible, the alveolar clefts are closed as well. The goal is primary repair of the primary palate. CONCLUSION: Although the principles of synchronous repair of the bilateral complete cleft lip and nasal deformity are established, the techniques continue to evolve. Bilateral nasolabial repair requires continual study of three-dimensional form and fourth-dimensional changes that are normal and altered by the deformity. Every surgeon who lifts a knife to care for these children has an obligation to periodically assess outcome.