摘要目的 探讨改进额部皮瓣的设计及转移方式行Ⅰ期鼻再造术. 方法 通过颈内、外动脉造影的影像学资料观察额部血供来源及分布情况,设计以一侧滑车上血管为蒂的额部不同部位皮瓣行鼻再造.额部存在多源性血供,滑车上动脉、眶上动脉于额骨眉突平面发出多条分支,颞浅动脉额支可见1条恒定、较粗大的水平分支,向额中部延伸,上述3条血管分支构成了额部丰富的肌层、皮下组织层血管网,呈立体分布.利用一侧滑车上血管为蒂分别切取同侧或对侧额部皮瓣,共行鼻再造术9例.结果 9例受术者皮瓣完全成活,再造鼻形态、功能均满意.结论以滑车上血管为蒂设计的额部跨区供血的皮瓣血运丰富,瓣远端分离出的肌筋膜瓣可以较好地包裹软骨支架,同时分离后的皮瓣更利于塑形,可以满足鼻再造的需求.

abstractsObjective To explore the design of forehead flap pedicled with supratrochlear artery and shift way for aesthetic reconstruction of the nose without secondary operations for debulking.Methods Origin of blood supplies and the distributed situation of the vessel in the frontal region were studied through the internal carotid artery and the external carotid artery X-ray angiography.The frontal region existed polyphyletic blood supplies,the supratrochlear artery and the supraorbital artery set out many branches,respectively,in the level of frontal bone eyebrow plane.One constant,thicker horizontal branch from the superficial temporal artery obviously extended to the forehead median.The branches from three blood vessels mentioned above constituted the network of artery adequate in the muscle and the subcutaneous tissue level,assumed the three-dimensional distribution in the forchead region.The nasal reconstruction had been done for 9 patients with the oblique orientation designed forehead flap by using one side of supratrochlear artery as the pedicle and cutting skin paddle with the same or the opposite side of forehead flap.Results All flap survived completely with the restoration of nasal shape and functional satisfaction.Conclusion The forehead oblique orientation flap pedicled with one side supratrochlear artery is nourished by the rich blood supply.The flap can be split into two flaps:a myofascial flap and a skin flap in far part.Myofascial flap may be the good package of cartilage framework,and simultaneously split skin flap is favorable of the shape models.The flap may satisfy the demand of the nasal restoration.