Reconstruction of a Nasal Ala Defect with Facial Artery Musculomucosal Flap and Conchal Cartilage Composite Graft-a Case Report

以顏面動脈支配之肌黏膜皮瓣以及耳後之軟骨複合皮瓣重建鼻翼部份全層缺損—案例報告

周鼎茂(Ting-Mao Chou) ； 李經維(Jin-Wei Lee)

《臺灣整形外科醫學會雜誌》 21卷1期 (2012/03) Pp. 60-65

https://doi.org/10.7096/TJTSPS.201203.0060

摘要

背景：鼻部的重建是相當複雜且具挑戰性的。在鼻翼部份的缺損重建，如要兼顧外觀以及黏膜部分的功能性，則單靠傳統的前額或者鼻唇皮瓣很難達到所有要求。因此，以肌黏膜皮瓣重建黏膜部，輔以耳後之軟骨複合皮瓣重建外觀，不失為一可行的治療選項。目的及目標：提出以顏面動脈肌黏膜皮瓣以及耳後之軟骨複合皮瓣重建鼻翼全層缺損之經驗。材料及方法：一位27歲的女性因右鼻翼處血管瘤接受多次冷凍治療後造成局部攣縮及變色。經手術切除變形部位後，產生之1.5公分見方的全層缺損，以顏面動脈支配之肌黏膜皮瓣重建鼻黏膜，輔以耳後之軟骨複合皮瓣重建鼻翼的軟骨及皮膚。結果：手術後病人的皮瓣均成功存活。儘管有部分的表皮產生蛇蛻以及疤痕肥厚，但在一段時間的局部壓迫及類固醇注射後，依然達到不錯的外觀。結論：以顏面動脈肌黏膜皮瓣以及耳後之軟骨複合皮瓣重建鼻翼部份全層缺損，可以同時重建外觀以及回復黏膜部將吸入之空氣加濕的效果，是一個可考慮的選擇。

並列摘要

Background:The nose is unique for its complex structure. Compound defect involving all three constituting layers of the nasal wall has been traditionally reconstructed with a forehead or a nasolabial flap plus-cartilage graft. Sometimes the nasal mucosal lining can be reconstructed with a musculomucosal flap from the buccal region.Aim and objectives:To share our experience of utilizing the facial artery musculomucosal (FAMM) flap and distant chondrocutaneous flap to reconstruct a full-thickness nasal alar defect.Materials and Methods:A 27-year-old lady with long existing atrophic deformity of the right nasal sidewall presented to the clinic for nasal reconstruction. A FAMM flap was utilized to restitute the nasal lining, which was topped with a chondrocutaneous graft to restore the missing framework and coverage.Results:The patient's postoperative course was uneventful. The FAMM flap and the cartilaginous part of the composite graft both survived well.Conclusion:The gratifying aesthetic result validates the feasibility of such an approach.

並列關鍵字

facial artery musculomucosal (FAMM) flap ； compound defect of the nose ； hemangioma