Nasal Reconstruction with the Reverse Flow Chondrocutaneous Preauricular Free Flap - A Case Report and Review of the Literature

以耳前軟骨游離皮瓣重建鼻缺損──病例報告及文獻回顧

Shyun-Jing Wee(黃循敬) ； Jian-Jr Lee(李建智) ； Hung-Chi Chen(陳宏基)

《臺灣整形外科醫學會雜誌》 32卷1期 (2023/03) Pp. 73-80

摘要

Background: The nose occupies a prominent feature in the face and always attracts visual attention. Any deformities of the nasal contours may result in a distorted appearance or nasal obstruction. There remains a great challenge for plastic surgeons to restore the delicate layered structures of the nose. Aim and Objectives: We aimed to report a case of the nasal defect following tumor excision, and the defect was reconstructed with the reverse flow chondrocutaneous preauricular free flap. Materials and Methods: A 65-year-old male presented with a 3×2cm irregular pigmented lesion surrounded by daughter tumors on the left nose and left cheek. Wide excision of the tumor was performed and was reconstructed with a right reverse flow chondrocutaneous preauricular free flap based on the ascending branch of the right superficial temporal vessels. Results: We successfully reconstructed the defect with a reverse flow chondrocutaneous preauricular free flap. The flap survived without any complications with a satisfactory result. At ten years of follow-up, there was no tumor recurrence. Conclusion: The chondrocutaneous preauricular free flap can be used for reconstruction with compose cartilage and skin for the nose. It is a delicate surgery that can achieve good functional and aesthetic outcomes with low morbidity in a one-stage operation. The reverse flow design can overcome the limitation of the short pedicle in an antegrade fashion.

關鍵字

nasal defect ； chondrocutaneous preauricular free flap ； reverse flow

並列摘要

背景：鼻子位於臉部最為突出的位置，也是視覺上最易被關注的結構。鼻部輪廓的變形或缺損將影響臉部整體的觀感。鼻部重建仍然是整形外科醫師的一個重大挑戰。目的及目標：我們報告一個腫瘤切除術後鼻部缺損的病例，接著以耳前軟骨游離皮瓣重建鼻部缺損，並達到優良的結果。材料及方法：一名65歲男性病患因左鼻和左臉頰一3×2公分不規則色素性腫瘤而就診。在進行廣泛性腫瘤切除後，以右耳前軟骨游離皮瓣進行鼻部缺損重建。此皮瓣之滋養血管為右淺顳動靜脈之上行支。結果：皮瓣存活且無任何併發症。病患於術後因左鼻有瘢痕攣縮的狀況，接受了瘢痕攣縮鬆解手術。術後患者對優異的結果感到非常地滿意。在隨訪的10年後，腫瘤並沒復發的跡象。結論：耳前軟骨游離皮瓣在鼻部缺損重建上具有低併發症，高成功率的結果。術後無論在美觀和功能上均能達到優異的結果。