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  [摘要]目的:改良传统额部扩张皮瓣行鼻再造的方法,克服再造术后的鼻外形臃肿、需二次手术整复等不足,提高鼻再造手术的质量。方法:手术分两期进行,一期在额部置入扩张器,扩张完成后,二期将扩张后的额部皮瓣分离成两个组织瓣,即含真皮下毛细血管网的超薄皮瓣和额肌瓣,利用肌瓣包裹鼻假体支架,利用超薄皮瓣完成鼻再造。结果:应用该方法行全鼻再造手术3例,皮瓣均成活良好,手术结果满意。结论:额部扩张后劈裂双瓣行全鼻再造,手术方法简单,解决了传统的额部皮瓣再造鼻手术后的臃肿和需二期整形手术问题,减轻了患者的负担,是值得推广的一种手术方法。

 [关键词]鼻再造;扩张;劈裂双瓣

 [中图分类号]R622[文献标识码]A[文章编号]008-6455(2010)07-0956-02

 Application of nasal reconstruction by use of the two splitted flap expanded

 LIU Ming-yu,CHEN Wei-hua,LI Wei,LIU Wei

 (Department of Plastic and Reconstructive Surgery,The Third Hospital of Harbin Medical University,Harbin 150001,Heilongjiang,China)

 Abstract:ObjectiveTo overcome the drawback of a clumsy nose,the need of secondary operation and to improve the outcome of the reconstruction, we designed the method of nasal reconstruction by means of improved traditional forehead expanded skin flap.MethodsThe operation is a two staged process.In the first step,a expander is inserted into the forehead region,and in the second stage the expanded tissue is separated into two portions (a ultrathin skin flap and a frontalis flap )when the expansion completed. The reconstruction of the nose is completed by the use of the ultrathin skin flap and the muscle flap to cover the prosthesis.ResultsThree patients are cured by this method ,all the flaps survived,and a perfect appearance obtained.ConclusionThe method of nasal reconstruction by use of the two splitted flap expanded should be recommended to more people for the reason of its advantage of simple technology,resolving the deficient of a fat nose and the need for the second operation of the traditional method,furthermore,it can relieve the patient's burden.

 Key words:nasal reconstruction;expander;two splitted flap

 鼻结构复杂精细,由不同的美学亚单位组成,鼻缺损的修复和再造对于整形外科医生来说是个挑战。鼻再造的手术方法很多,因前额的皮肤颜色和质地与鼻部相接近,额部皮瓣是进行全鼻再造的首选方法之一。但由于以往的手术切取的皮瓣含有额肌,鼻再造手术后外形臃肿,给二期手术带来了难度,我们应用额部扩张后劈裂双瓣行全鼻再造,成功地治疗了3例手术和外伤后鼻缺损的患者,取得了较好的手术后效果,现报道如下。

 1资料和方法

 1.2 临床资料:本组患者3例,其中男1例,女2例,年龄17～35岁,平均25岁。狗咬伤后瘢痕愈合1例,血管瘤术后鼻部分缺损1例,烧伤后鼻缺损1例。

 1.2 方法

 1.2.1 额部扩张器埋置:一期手术在局麻下选用150ml肾形扩张器埋置于前额正中额肌下,经过2个月的常规注水,注水量在260～310ml[1]。

 1.2.2 额部扩张后劈裂双瓣全鼻再造手术:手术在全麻下进行,选择翻转瘢痕组织瓣作为鼻部的衬里,通过额部扩张后皮瓣的透光实验,确定额部滑车上动脉走行,在扩张皮肤上设计三叶皮瓣,设计时应略大于缺损面积,手术切开三叶瓣远端,锐性分离皮肤和额肌,形成带有真皮下毛细血管网的超薄皮瓣和带有额肌的肌瓣,在额部皮瓣蒂部眉间区设计三角形瓣,避免蒂部扭转和减少皮瓣的张力 ......