Reconstructive Options in the Management of Traumatic Amputation of the Nose -- A Rational Approach

外傷性鼻截肢的重建選擇──合理的治療流程

Ting-Han Chiu(邱亭翰)；Hsiang-Shun Shih(施翔順)；Seng-Feng Jeng(鄭勝峯)

nose amputation ； reconstruction ； replantation ； trauma ； forehead flap

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

161 - 173

英文;繁體中文

Background: The nose is susceptible to trauma due to its central and prominent position on the face. Consequently, restoring both the functional and esthetic aspects of the nose after traumatic amputation presents a complex challenge. Aim and Objectives: To retrospectively review the reconstruction methods and outcomes of traumatic nasal amputations treated by our team and to provide a comprehensive management protocol. Materials and Methods: We performed a 30-year (1991-2021) retrospective review of patients who underwent post-traumatic nasal reconstruction with various surgical techniques ranging from local and regional flaps to microvascular replantations. Based on our findings and clinical expertise, we devised a step-by-step strategy for treating traumatic nasal amputations. Results: A total of 14 patients were included in this study, consisting of five nasal microsurgical replantations, two of which failed and received a forehead flap and a nasolabial flap for salvage reconstruction respectively; other included six forehead flaps as a primary procedure for nasal tip and alar defects, one local flap for an ala defect, one nasolabial flap for alar and nasal sidewall defects, and one degloving composite midface injury treated with primary suturing. Our findings showed very good results with the successful replantation of the amputated nose. Particularly, we observed that the forehead flap was commonly utilized for various-sized defects in different subunits of the nose, either during primary or secondary procedures. Conclusion: Direct replantation provides a better esthetic outcome compared to other reconstructive options. Therefore, it should be considered for any major traumatic nasal amputation. However, in cases where replantation fails or is unfeasible, the forehead flap may be considered an excellent donor option for correcting traumatic nasal defects.

背景：鼻部由於位處面部中央且較突出而容易受到外傷，然而創傷性鼻截肢後的重建卻很難恢復鼻子的功能和細微美學差異。目的及目標：回溯本團隊創傷後鼻重建病人的重建方法及成果，對此類病人的處置提供更完善的處置方針。材料及方法：針對過去三十年（從1991年至2021年）使用局部或區域皮瓣到顯微重接等手術技術所進行的創傷後鼻重建患者進行了回溯性研究。作者回顧本團隊己身的臨床經驗，同時提出了對於治療創傷性鼻截肢的一套流程。結果：本研究共收入14例患者，其中5例接受鼻殘肢顯微手術重接，其中2例重接失敗案例分別接受前額皮瓣及鼻唇溝皮瓣二次重建，其餘案例有6例以前額皮瓣作為鼻尖和鼻翼缺損的初級修補，1例局部皮瓣修復鼻翼缺損，1例鼻唇溝皮瓣修復鼻翼和鼻側壁缺損，1例複雜顏面撕脫傷接受初級縫合治療。作者在鼻截肢顯微重接手術案例上取得了非常成功且好的結果，而前額皮瓣無論是作為初級修補手術還是二次處置，皆可有效用於修復鼻子不同次單位、各式大小的缺損。結論：在任何重大創傷性鼻截肢中，如果能直接顯微手術重接，其成果遠比其他重建方案能提供更好的美學效果，因此應盡可能優先考慮。當重接失敗或不可行時，使用前額皮瓣重建是對於任何創傷性鼻部缺陷的理想選擇之一。