厚皮鼻整形术的结局优化：手术操作与围手术期医疗管理——一项叙述性综述

文献信息

中文摘要

管理致密的鼻软组织包膜（STE）仍然是面部整形外科中的一项艰巨挑战。本叙述性综述旨在评估与厚皮鼻整形术相关的解剖学挑战，回顾术中结构性操作，并评估围手术期医疗干预——特别是异维A酸——的疗效。我们利用PubMed/Medline、Scopus、Web of Science和Embase进行了全面的文献检索，获取了关于解剖变异、手术技术和医疗管理的文献。厚鼻部皮肤本身缺乏弹性，使患者易出现术后水肿延长、死腔增加以及掩盖下方软骨轮廓。所回顾的文献提示，与单纯积极软组织去脂（其存在血管损伤风险）相比，主要依赖坚固结构性移植（如鼻小柱支撑移植物和鼻中隔延伸移植物）的术中策略在长期投影方面表现更优。此外，术前皮肤调理与术后口服或局部异维A酸的整合，似乎是减少皮脂腺活动和加速水肿消退的有前景的辅助手段。然而，关于异维A酸的结论必须有所保留，因为当前研究受限于样本量小、方法学异质性以及缺乏经过验证的患者报告结局指标（如FACE-Q）。在厚皮鼻整形术中实现最佳效果需要多模式方法。术中坚固的软骨支撑、细致的死腔管理以及审慎的、个体化的药物治疗的协同组合，可能有助于减轻术后纤维化并改善美学效果。

英文摘要

Managing the dense nasal soft tissue envelope (STE) remains a formidable challenge in facial plastic surgery. This narrative review aims to evaluate the anatomical challenges associated with thick-skinned rhinoplasty, review intraoperative structural maneuvers, and assess the efficacy of perioperative medical interventions-specifically isotretinoin. A comprehensive literature search was conducted utilizing PubMed/Medline, Scopus, Web of Science, and Embase, yielding literature on anatomical variations, surgical techniques, and medical management. Thick nasal skin is inherently inelastic, predisposing patients to prolonged postoperative edema, increased dead space, and the masking of underlying cartilaginous definition. The reviewed literature suggests that intraoperative strategies relying heavily on robust structural grafting (e.g., columellar struts and septal extension grafts) demonstrate superior long-term projection compared to aggressive soft-tissue defatting alone, which carries risks of vascular compromise. Furthermore, the integration of preoperative skin conditioning and postoperative oral or topical isotretinoin appears to be a promising adjunct to diminish sebaceous gland activity and accelerate edema resolution. However, conclusions regarding isotretinoin must be moderated, as current studies are limited by small sample sizes, heterogeneous methodologies, and a lack of validated patient-reported outcome measures (e.g., FACE-Q). Achieving optimal results in thick-skinned rhinoplasty requires a multimodal approach. The synergistic combination of rigid intraoperative cartilaginous support, careful dead-space management, and judicious, patient-specific medical therapies may help mitigate postoperative fibrosis and improve aesthetic outcomes.