- 期刊
One-Block L-shape Autologous Rib Cartilage Graft for Nasal Reconstruction
單一L型自體肋軟骨在鼻重建手術之應用
摘要
Background: Nasal reconstruction is challenging due to its 3D appearance and functional and aesthetic considerations. A stable framework, sufficient skin envelope, and nasal lining are necessary. The literature suggests multiple cartilage grafts, including spreader, tip, columella, derotation, and supratip grafts, for refinement, elongation, augmentation, derotation, and enhancement of the framework support. Rib cartilage is the most common donor graft due to its abundance, hidden scar, and multiple capacities. Aim and Objectives: There are difficulties of framework issues encountered during total or subtotal nasal reconstruction based on the inadequate and insufficient previous framework support, including defects of the septum and upper or lower lateral cartilage. We report the use of a one-block L-shaped autogenous cartilaginous rib graft to reconstruct the framework and to achieve an optimal aesthetic outcome. Materials and Methods: We retrospectively reviewed cases for nasal framework reconstruction from March 2020 to January 2022. The technique was used to treat total or subtotal nose defects caused by malignancy, congenital deformity, benign neoplasm, or trauma. Patients who had less than 2 months of follow-up were excluded. Patient demographics, clinical history, operative details, postoperative results, and complications were obtained from electronic medical records. We assessed graft resorption, maintenance of projection, and warping through physical exams and photographic analysis. Informed consent was obtained from all patients. Results: 12 patients underwent the described framework reconstruction with an average age of 43.5 years (range, 18-82 years). The patients had various reasons for reconstruction - Wagener's granulomatosis, malignant, traumatic, and iatrogenic etiologies; more than half had undergone previous nasal surgery. Average follow-up time was 13 months (range 6-24 months), with almost all patients having more than 1 year of follow-up. Only one patient had forehead flap partial loss, but the wound healed secondarily after 6 weeks of wound care. No donor site morbidity occurred. Conclusions: The L-shape autologous rib cartilage graft is suitable for patients with septum defects or instability of the keystone area. The graft can serve multiple purposes, including acting as two spreader grafts, a columella strut, a supratip graft, a shield graft, and a cap graft. The technique provides a stable and secure connection between the dorsal strut and the columella, which can improve both the structural support and aesthetic outcome of the procedure.
並列摘要
背景：在鼻整形重建中，由於其三維外觀以及功能性和美觀上考量，鼻重建具有挑戰性。穩定的框架、足夠的外在皮膚包覆和鼻腔內襯裡是必要的。文獻建議使用多個結構軟骨，用於雕塑、延長、疊加、去旋轉和增強框架支撐。肋軟骨是最常見的重建材料，因為軟骨量、隱藏的疤痕等好處。目的與目標：先前框架支撐不充分可能會導致重建過程中出現問題，在全鼻或次全鼻重建過程中遇到框架問題的困難，包括鼻中隔和上或下外側軟骨的缺陷。這可以通過單一L形自體肋軟骨來解決。本研究之目標是要討論及呈現單一L型自體肋軟骨在鼻整形重建中所達到的美觀及成果。材料及方法：我們回溯性分析了2020年3月至2022年1月的鼻重建病患。病患接受手術原因多用於治療由惡性腫瘤、先天性畸形、良性腫瘤或外傷引起的全鼻或次全鼻缺損。從病歷中獲得患者分佈、病史、手術相關細節、術後結果和併發症。我們通過照片分析評估自體肋軟骨的吸收狀況、術後鼻型。結果：12名患者接受單一L型自體肋軟骨框架重建其鼻部缺損，平均年齡為43.5歲。患者進行重建的原因多樣，包括惡性腫瘤切除術後、外傷性和醫源性病因；超過一半的人之前接受過鼻部手術。平均追蹤時間為13個月。只有一名患者前額皮瓣部分脫落，並在6週之後癒合。沒有發生任何肋骨併發症。結論：L形自體肋軟骨適用於有鼻中隔缺損或Keystone區域不穩定的患者。L形自體肋軟骨可用於多種用途。此技術在在鼻梁支撐及鼻小柱之間提供了穩定和安全的連接，可以改善手術的結構支撐和美學效果。