Reconstruction of external nose defect with local flaps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The role of different local flaps in small external nasal skin defect reconstruction was discussed.@*METHOD@#Forty-two cases of the small size nasal defects (diameter < 2 cm) were repaired with local external nose flap (includes the dorsal nasal flap, nasolabial flap and bilobed flap). The clinical and follow-up data were analyzed of patients with small external nasal skin defects, who accepted different local flaps reconstruction. Dorsal nasal flap, nasolabial flaps (includes island flap, slid flap and axial flap) and bilobed flap were tailored to reconstruct different external nasal defect. Twenty-seven patients were male and fifteen patients were female, the patients' age ranged from 28 to 74 years, the median age was 61 years. Thirty-eight cases resulted from resection of skin malignant tumor and four cases were benign lesions. The diameter of defects was 1-2 cm. The defects were reconstructed by single-stage dorsal nasal flap in 7 cases. There were 30 cases of caudolateral nasal defects were reconstructed by nasolabial flap, single-stage island nasolabial flap in 7 cases, axial flap in 18 cases and slid flap in 5 cases. Superior lateral defects were reconstructed by single-stage bilobed flap in 5 cases.@*RESULT@#All defects were repaired successfully. All tissue flaps survived and had not necrosis. There was no tumor recurrence during 3 months to 2 years follow-up.@*CONCLUSION@#The dorsal nasal flap, nasolabial flap and bilobed flap can be used safely and effectively to repair the small external nasal defect and have satisfactory curative effect.

Endoscopic reconstruction skull base using pedicled nasoseptal flap and its anatomy measurement / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success.@*METHOD@#The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap.@*RESULT@#The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2.@*CONCLUSION@#One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.

Reconstruction of large external nose defect with forehead flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the role of forehead flap in large external nasal defect reconstruction.@*METHOD@#We retrospectively reviewed the clinical and follow-up data of 11 patients with large or full-thickness external nasal defects, which were reconstructed with single-or two-stage interpolated or island forehead flaps from January 2007 to June 2011. All patients were male,defects of 9 cases were resulted from resection of skin malignant tumor and traumatic defect in 2 cases. The average diameter of defects was 3.3 cm (2.5-5.0 cm). Four cases had alar full thickness defect. The supratrochlear and angular artery of the elders (>70 yrs) and patients with suspicious peripheral blood vessel lesions were scanned before the surgery by Doppler ultrasonic. The defects were reconstructed by two-stage interpolated flap in 7 cases; five cases were reconstructed by single-stage island flap technique. A nasolabial flap based on piriform aperture was turned into the nasal cavity to reconstruct the lining.@*RESULT@#All defects were repaired successfully. All tissue flap survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain at the 6th postoperative month.@*CONCLUSION@#The forehead flap, interpolated or island, can be used safely and effectively to repair the large external nasal defect in experienced hands.

The role of MR and endoscopy in postoperative management of skull base reconstruction by vascular pedicle septal flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the significance of MR and endoscopy in the postoperative management of skull base reconstruction with a vascular pedicle nasoseptal mucoperiosteal flap.@*METHOD@#The immediate, and delayed postoperative MR imaging scans and endoscopic data of 8 patients who underwent endonasal endoscopic reconstruction of skull base dural defects with a vascular pedicle nasoseptal mucoperiosteal flap were retrospectively studied. Among the 8 patients, 7 cases have integrated immediate, delayed postoperative MR and synchronous endoscopic data which were harvest at the first week and at a 3- to 7-month interval respectively. One case was followed up by CT and endoscopy. The intracranial parenchymal changes, local situation of skull base defect site, the septal flap, healing of flap donor site and the transition of naso sinus mucosa were fully evaluated to explore the healing process and to improve the success rate of the reconstruction.@*RESULT@#We can obtain the key postoperative information of intracranial and the skull base reconstruction site with MR and endoscopy. The MR can exclude the intracranial complications such as postoperative intracranial hematoma, cerebral edema, or pneumocephalus, and clearly show the location and extent of skull base defects, the position of the flap, the overlapping manner between the dural defect margin and the flap and the postoperative cerebrospinal fistula. In immediate and postoperative follow-up with MR, the septal flap had homogeneous enhanced image with a roughly "C" figure under the skull base, indicating stable blood supplement. The synchronous endoscopic examination also proved the survival of the septal flaps in 7 cases , the cerebrospinal fluid leakage in 1 case. One case flap necrosis. The septal flaps presented edema and congested in the immediate postoperative endoscopy, and returned to normal in the delayed examination. The non-vascular materials such as gelatin sponge and fat tissue had the different characteristics signal. Nasal mucosal edema and sinus ventilation continually recovered during the follow up and the exposed septal cartilage on the donor site resurfaced by mucosa in 2 months.@*CONCLUSION@#MR and endoscopy could provide the critical postoperative information about the vascular pedicle septal flap reconstruction. MR combined with endoscopy not only could rule out the complications, but also could gain the information such as the position, blood supply and healing of the flap, at the same time detected the cerebrospinal fluid leakage to provide accurate information for the secondary stage reconstruction. The information got from MR and endoscopy were important for the surgeon and the radiologist to recognize the flap and to evaluate for variations that may suggest potential flap failure.