CAJ | 학술논문

目的探讨携带少量额肌的前额旁正中皮瓣行鼻缺损修复和鼻再造术的可行性和临床意义.方法采用仅蒂部携带额肌的改良旁正中皮瓣法,完成2例鼻再造和7例鼻缺损修复术.除眶上区的蒂部携带少量额肌外,皮瓣获取均在皮下层次.皮瓣的轴线角度从垂直90°到倾斜50°不等,其中3例低发际线患者,采用倒L形设计.结果一期皮瓣形成和二期皮瓣断蒂术中,观察到长距离行走皮下脂肪层的滑车上血管皮支的存在,以及良好的动脉灌注压.8例皮瓣全部成活,皮瓣质地和色泽良好.采用皮下蒂法1例术后皮瓣周边血运障碍,经换药自愈.结论滑车上血管皮支的存在是改良旁正中皮瓣应用的解剖学基础.仅蒂部携带少量额肌的旁正中皮瓣具有设计较灵活,成活良好,质地合适,皮肤颜色匹配,以及供区损伤更小等优点.采用改良旁正中皮瓣行鼻再造或鼻缺损修复,能满足血运和形态的双重要求.
목적 탐토휴대소량액기적전액방정중피판행비결손수복화비재조술적가행성화림상의의.방법 채용부체부휴대액기적개량방정중피판법,완성2례비재조화7례비결손수복술.제광상구적체부휴대소량액기외,피판획취균재피하층차.피판적축선각도종수직90°도경사50°불등,기중3례저발제선환자,채용도L형설계.결과 일기피판형성화이기피판단체술중,관찰도장거리행주피하지방층적활차상혈관피지적존재,이급량호적동맥관주압.8례피판전부성활,피판질지화색택량호.채용피하체법1례술후피판주변혈운장애,경환약자유.결론 활차상혈관피지적존재시개량방정중피판응용적해부학기출.부체부휴대소량액기적방정중피판구유설계교령활,성활량호,질지합괄,피부안색필배,이급공구손상경소등우점.채용개량방정중피판행비재조혹비결손수복,능만족혈운화형태적쌍중요구.
Objective To investigate the feasibility and significance of modified paramedian forehead flap for nasal defect and reconstruction. Methods Modified paramedian forehead flaps with forehead muscle in the pedicle were used in 2 patients with nasal reconstruction and 7 patients with nasal defects. The flaps were elevated subcutaneously with only forehead muscle in the pedicle at the supraorbital site. The degree of flap axis ranged from 90°to 50°. Inverted L-shape design was used for 3 cases with low hair line. Results Skin branch of supratrochlear vessel was observed running at the subcutaneous layer during the operation. 8 flaps all survived successfully with good texture and color. Partial necrosis happened in the distal end of one flap with subcutaneous pedicle, which healed through dressing.Conclusions Modified paramedian forehead flap, which includes muscle just in the pedicle, is based on the skin branch of supratrochlear vessel. The flap is very flexible and has reliable blood supply, leaving less morbidity in donor site. It also has good texture and skin color.