- 期刊
The Subcutaneous Pedicle Nasolabial Flap-A Modified Technique for Midface Reconstruction
改良式皮下組織蒂鼻唇皮瓣於中臉的重建
摘要
背景：鼻唇皮瓣因為鄰近且皮膚質地相似，長久以來被應用於中臉的重建，然而，執行鼻唇皮瓣時通常必須破壞顏面單元間的邊界或為了保留而必須執行二階段的手術。目的及目標：改良鼻唇皮瓣手術的方法，並應用於一系列病人身上，來提升中臉部重建手術的結果。材料與方法：從2003年11月到2012年2月，有十二位接受改良式皮下組織蒂鼻唇皮瓣於中臉的重建。有四位顏面缺損在上唇，一位在臉頰，而有七位在鼻部。大多數顏面缺損為基底細胞癌及鱗狀上皮細胞癌切除術後，而只有一位年輕男性是因移除上唇疤痕形成。在改良鼻唇皮瓣手術的方法中，我們利用皮下組織蒂島狀鼻唇皮瓣穿過皮下通道來重建顏面缺損。可以安全地執行長寬比達5比1的皮瓣而不會危及其血液循環。皮瓣的樞軸到顏面缺損間設計的皮下通道可以保持皮膚完整性，進而保持顏面單元的完整。結果：十二位病人接受這改良式皮下組織蒂鼻唇皮瓣於中臉的重建，有六位男性及六位女性，平均年齡64歲。所有皮瓣都存活並無壞死且病人有滿意的結果，而供皮區並無併發症的產生且疤痕不甚明顯。結論：利用改良式皮下組織蒂鼻唇皮瓣於中臉的重建可提供維持顏面單元完整、單次手術、不會有皮膚蒂鼻唇皮瓣中會產生的狗耳朵變形等好處。它同時也提供可信賴鼻唇皮瓣，可有較大長寬比、較大轉動弧、可由上或下為基底的皮瓣蒂及較少供皮區的併發症。
關鍵字
無資料並列摘要
Background:Nasolabial flaps have long been used to reconstruct the midfacial defects because of their proximity and matching of skin texture. However, when performing a pedicle nasolabial flap, it is always necessary to disrupt borders that separate aesthetic regions or it necessitates second stage operation for pedicle division if it crosses over them.Aim and Objectives:We described a series of nasolabial flap procedures to illustrate how the modified technique can improve the results of midface reconstruction.Materials and Methods:From November 2003 to February 2012, nasolabial flaps in the modified technique were used for midface reconstruction in 12 patients. The facial defects were on the upper lip in four cases, the cheek in one case and the nose in seven cases. All of the skin and soft tissue defects resulted from radical resection of basal cell carcinoma and squamous cell carcinoma except one on the upper lip of a young male after removal of an unsightly scar.In the reconstructive procedure, we made the flap as a subcutaneous pedicle island flap that reached the facial defect through a subcutaneous tunnel. Surgery using a 5:1 length-to-width ratio from the pivot point to the tip of the flap was safely performed without compromising the circulation of the flap. A subcutaneous tunnel was made between the pivot point of the flap and the defect to keep the skin intact, thereby preserving the nasofacial boundaries and facial subunits.Results:Twelve patients, 6 males and 6 females with an average age 64 years, underwent midface reconstruction with nasolabial flap using the modified technique. All flaps survived completely without loss or donor site morbidity. All patients had satisfactory results with only an inconspicuous scar on the donor site.Conclusion:Performing nasolabial flap procedure for midface reconstruction using the modified technique offers the advantages of preservation of facial topography in a one stage operation while avoiding dog ear formation which can develop in cutaneous pedicle nasolabial flap. This durable nasolabial flap has a large length to width ratio, a big arc of rotation, a superiorly or inferiorly based pedicle and minimal donor site morbidity.