Rhinoplasty

The external part of the nose is damaged or damaged, and it needs to be transplanted with a pedicle flap. Surgery is often done in fractions and takes longer. Treatment of diseases: nasal traumatic nasal bone fracture Indication The external part of the nose is damaged or damaged, and it needs to be transplanted with a pedicle flap. Surgery is often done in fractions and takes longer. Preoperative preparation Each operation must be strictly protected against infection, ensuring a sufficient blood supply to the flap. If the patient has an acute infection or bloated, it should be actively controlled, and surgery can be performed after recovery. In addition, it is important to pay attention to factors affecting blood supply, such as colder climate, post-radiation treatment, newer scars, etc., should be fully estimated before surgery. There are two types of graft flaps: the forehead flap and the arm flap. The former is relatively simple and easy to operate, but the disadvantage is that the forehead will leave scars, and the forehead skin is limited, the forehead is small or the defect is better, the skin may not be enough; the arm flap is taken from the inside of the upper arm, the flap Can be larger, but must first be made into a skin tube, after the blood supply is improved, then the proximal end is transplanted to the nasal root, and then the blood supply at the nasal root transplantation can make the skin survive, then cut off the distal end, open the skin The tube performs a skin surgery. Surgical procedure (1) Forehead flap method This is a flap of the entire forehead part of the forehead. The pedicle maintains blood supply from the contralateral superior iliac artery. If the whole nose is formed, the distance from the tip of the eyebrow to the hairline should be at least 7cm. If it is 8-9cm, the nose shape can be more ideal. Women with smaller noses, sometimes 5cm can barely be used. It should generally be estimated that the flap may shrink. 1. Both eyes are first coated with antibiotic eye ointment and the face is disinfected with 0.1% thiomersal. 2. Local anesthesia with 1% procaine infiltration. 3. Make two upper and lower skin incisions in the forehead. The lower edge incision starts from the inner end of the eyebrow and crosses the upper edge of the eyebrow arch across the eyebrow to the temporal side. The upper margin incision starts from the midpoint of the upper edge of the eyebrow arch, and then bends upward to the middle of the forehead hairline, and then extends along the hairline to the temporal side. The subcutaneous tissue between the free incisions is deep in the middle of the forehead just above the surface of the periosteum. The depth on the outside should be above the fascia. Care should be taken to keep the pedicle thick when dissociating. 4. Cut the cortex at the lateral ends of the upper and lower incisions to form the distal end of the flap. At this point you can lift the flap up to the pedicle. Generally, for a few minutes, if the skin color is constant and there is continuous bleeding, it means that the flap can have enough blood supply when transplanted. Cover with saline gauze for use. 5. Carefully determine the edges of the nose, nose and nose around the face and nose. If necessary, mark with a purple. Note if it is symmetrical, then use a small round knife to cut along the marked edge. 6. Peel the skin from the incision to the edge of the nasal defect hole until the peripheral portion of the nasal defect hole, and turn the peeled skin toward the defect, the skin of the skin facing outward, and suspend the inverted flaps as a lining. 7. Transfer the forehead flap to the nose, first fold the distal end of the flap inward, then fold the shape of a small column in the midline, sew with a thin thread, and fix the seam at the nasal defect. The parts of the column are trimmed with excess skin and then sutured to the edges of the lining to form a nasal vestibule on both sides. Finally sutured to the sides along the nose (Figure 4). The outer nose is initially formed. 8. Forehead wounds can be covered in the inner thigh, covered with a layer of skin, sutured the edges, and pressure bandaged. 9. Remove the suture in about 1 week. After 10.3 to 4 weeks, the flap was cut at the base of the nose, and the base of the nose was sutured to the root of the flap. After cutting the flap, the excess skin should still be laid back to the original forehead suture. Disassemble the line after 1 week. (B) the application of the arm flap method arm flaps generally take the skin on the inner side of the left upper wall, you need to make a skin tube and then transplanted to the nose, and then cut open for nasalplasty. The length of the skin tube should not be shorter than 10~12cm. Otherwise, the length of the tube may be insufficient due to the length and the tension is too large, which may hinder the operation. The width of the skin tube should not be less than 1/2 of the length, otherwise the transplant may fail due to insufficient blood supply. The first stage of surgery: tube angioplasty. 1. Disinfect the inside of the left upper arm twice with 0.1% thimerosal. Cover the area around the surgical field with a disinfectant towel. Use a sterile steel ruler to measure the length and width of the flap. If it is 12cm×8cm, it is ideal (the upper arm is thinner or the nose is smaller, it can be slightly narrower). A purple lined out the length lines on both sides. 2. According to the nail purple mark, make a straight skin incision on both sides, deep into the subcutaneous fat. 3. Separate the subcutaneous tissue between the two incisions and retain some of the fat under the skin. Until the skin between the incisions on both sides is completely free. 4. Invert the incisions on both sides of the flap inward, and suture with silk thread until the ends can not be closed. 5. If the wound of the arm is loose, the skin on both sides can be loosened and sutured at the opposite end. Otherwise, the wound is covered by the inner layer of the thigh. Then covered with Vaseline gauze and then gauze pressure bandage. 6. Unbundle about 7 to 10 days and remove the suture. The second operation: 3 weeks after the first operation, if the wound has completely healed, the upper arm can be made into the proximal end of the skin tube, and the rubber band is ligated to a certain tightness. After 10 minutes, the skin tube is discolored. If there is no color change, the ligation time can be extended the next day. Such a daily ligation observation, if it can be ligated for about 1h, the color remains unchanged, indicating that the blood supply is sufficient, and the second operation can be performed. 1. The face and upper arm skin tube and its surrounding skin are disinfected with thimerosal. Covered with a disinfectant towel. 2. Cut the proximal end of the skin tube. 3. Suture and wrap the wound of the arm at the end of the skin tube. 4. Make an arc-shaped incision at the site of the nasal root preparation for the graft, separate the subcutaneous tissue, and turn it down so that the wound surface is equal to the size of the cross-section of the skin tube. 5. Bend the left arm upwards so that the palm can be attached to the top of the head. The proximal end of the tube can be connected to the root of the nose, and then the end of the tube is sutured to the base of the nose with a silk thread, and the bandage is applied. 6. Fix the left arm to the head with a plaster bandage so that the tube does not have tension and remove the suture after 10 days. The third operation: After 3 weeks of the second operation, a blood supply has been established between the nasal root and the skin tube. At this time, there is still a rubber band trial to fasten the upper arm end of the leather tube, and the blood tube is tested as before the second operation. Whether the supply is sufficient, if the color is unchanged for more than 1 hour, the third operation can be performed. Remove the fixed plaster before surgery. 1. Disinfect the same as before, local anesthesia with 1% procaine injection. 2. Cut the end of the leather tube, suture the wound of the arm, and gently put the upper arm down after dressing. The activity of the arm can gradually recover itself afterwards. 3. Cut the skin tube along the original suture, cut off the subcutaneous fat, and remove the scar on the edge. 4. The following procedure is the same as that for nose shaping with a frontal flap.