total nose reconstruction

Most or all of the external nose is deficient due to various reasons, and full nasal reconstruction is required to restore its shape. The entire nose causes the skin tissue required for the shape, mainly with flaps or tubular flaps. Commonly used are frontal flaps, upper arm tubes, shoulder and chest tubes, and vascular pedicles or free forearm flaps. The former frontal flap is the best, because its tissue is thin, the blood supply is rich, the shape and color are ideal, the shape is stable, the contraction is small in the later stage, and in the flap transfer, no limb fixation is required, and generally no cartilage support is needed. Satisfactory shape. The disadvantage is that the forehead donor area leaves traces of free skin grafting, which affects facial beauty. Skin spreaders are now used to expand the forehead skin for nasal reconstruction to avoid problems left by free skin grafts. The following focuses on the surgical procedure of the frontal flap. Treatment of diseases: nasal trauma Indication Total nasal reconstruction is applicable to: Most or all of the nose is damaged due to severe nasal trauma, infection or burns. Preoperative preparation 1. Regular examination before general anesthesia. 2. Explain the way of nasal reconstruction to patients and their families. 3. Matching blood 300~600ml. Surgical procedure 1. The design of the frontal flap The mid-frontal flap is blood-supply with the upper and middle iliac artery. Forehead oblique flap, choose one side of the superior iliac artery as pedicle. 2. Forehead median flap nasal reconstruction surgery steps (1) Cut the skin and subcutaneous according to the design of the flap, and separate it on the surface of the frontal muscle, pick up the flap, and take care to avoid damage to the blood supply artery. (2) After the flap is well stopped, the lifted flap is rotated 180°, sutured with the formed lining tissue, and the pedicle is tubularly closed. (3) Free skin grafting for the valve area, and re-creating the dilatation tube in the anterior nasal cavity. (4) 3 to 4 weeks after surgery, the base of the nose will be reconstructed and the suture will be flattened. (5) The first-stage median flap is reconstructed in the first stage, and the nasal valve pedicle can be left under the skin to form an island-shaped flap, which is transferred to the nose by a 180° rotation through the subcutaneous tunnel of the nasal root. (6) For the forehead skin expansion method, the volume should be 150-200ml, and the rectangular skin soft tissue expander should be buried in the deep surface of the frontal muscle in the middle of the forehead. The incision was released from the frontal part of the forehead to the upper part of the eyebrow. At 1 week after the operation, the saline was injected into the dilator, and the expansion was gradually completed within 6 to 8 weeks. After the dilator was removed, the incision was made and the upper artery of the trochlear was removed. The median island flap of the forehead, the nose forming process is the same as described above, and the wound can be directly formed into the suture.

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