Staged Reconstruction of Nasal Alar Defect with Tunneled Nasolabial Flap and Conchal Cartilage Graft - A Case Report and Literature Review

以鼻唇皮瓣及耳郭軟骨移植二階段之重建鼻翼全層缺損－病例報告及文獻回顧

陳治有(Chi-Yu Chen) ； 魏林瑰(Lin-Gwei Wei) ； 張舜程(Shun-Cheng Chang) ； 林進達(Chin-Ta Lin) ； 陳錫根(Shyi-Gen Chen) ； 高全祥(Chuan-Hsiang Kao) ； 陳天牧(Tim-Mo Chen)

《臺灣整形外科醫學會雜誌》 24卷1期 (2015/03) Pp. 37-43

摘要

背景：重建全層鼻翼缺損是很困難且極具挑戰性的，主因是鼻部複雜的三度空間結構，及與正常一側鼻翼對稱性之要求。目的與目標：對於鼻翼缺損的重建在過去已經有許多局部和遠端皮瓣的方式被提出。我們提出鼻翼的缺損以鼻唇皮瓣來做第一階段的軟組織重建，第二階段則選擇耳廓軟骨來加強重建後的鼻翼支持結構以期能夠提供理想的功能和美觀。材料及方法：一名60歲男性因為臉部創傷造成右側鼻翼全層的缺損，在急診手術時，他接受右側鼻翼複合移植手術，三天後，複合移植出現局部壞死，創傷後的三個月後，我們選擇階段性手術重建：第一階段先以鼻唇皮瓣重建軟組織缺損，第二階段在第一階段手術後六個月再以耳廓軟骨移植加強重建後的鼻翼支持結構。結果：術後追蹤一年，本病患對於重建後鼻翼的外形感到滿意，吸氣時也沒有氣道阻塞或是鼻翼回縮的情形，但鼻孔狹窄的情形仍然存在而需要更進一步的重建。供應區的疤痕則隱藏在鼻唇溝內。結論：經由本病例的探討，對於全層鼻翼缺損選擇以鼻唇皮瓣及耳廓軟骨移植之二階段重建，在功能以及外觀上都能提供可接受的結果。

並列摘要

Background: Reconstruction of complete loss of nasal ala is difficult and challenging due to the complexity of the three-dimensional anatomy and requirement of symmetry to the normal side. Aim and objectives: Various local and distant flaps have been described for the reconstruction of nasal alar defects. We propose staged reconstruction of soft tissue defect with tunneled nasolabial flap, followed by conchal cartilage graft for the reinforcement of the framework in order to provide better functional and aesthetic results. Materials and methods: A 60-year-old man who was admitted due to complete loss of the right nasal ala resulted from a severe facial trauma. At emergency surgery, he received composite graft using defatted avulsed nasal ala. Unfortunately, it failed with necrosis. 3 months after injury, a tunneled nasolabial flap was used for soft tissue defect coverage. 6 months later, a conchal cartilage graft from ear was used for enhancing the support of nostril contour. Results: The shape and texture of the reconstructed nasal ala were acceptable without alar retraction or airway obstruction during inspiration. However, narrowing of the nostril still exists which requires further reconstruction. The donor site scar was concealed in the nasolabial fold. Conclusion: Staged reconstruction of complete nasal alar defect with tunneled nasolabial flap and conchal graft provide both functionally and esthetically acceptable results.

並列關鍵字

alar defect ； nasolabial flap ； conchal graft