治疗重度鼻整形术后鼻前庭狭窄的多模式挽救方案：一例病例报告

文献信息

中文摘要

背景： 重度鼻前庭狭窄是一种日益被认识到的美容性鼻整形术医源性并发症。多次修复的病例尤其难以处理，因为既往手术可能损害前庭微循环，而单纯长期支撑又存在缺血性再狭窄的风险。我们描述了一种个体化的、分阶段的多模式挽救方法，并在单例患者中加以说明。方法：第1阶段通过瘢痕切除、局部皮瓣和定制支架重新开放阻塞的前庭，随后进行约3个月的冷大气等离子体（CAP）和每月病灶内注射富血小板血浆（PRP），旨在调理瘢痕床并改善组织柔韧性。第2阶段根据解剖缺陷提供确定性的美学重建，并辅以12个月的辅助方案，包括逐渐减量的鼻腔支撑、切口周围PRP、交替使用抗菌和伤口愈合模式的CAP循环，以及浓度递增（5-40 mg/mL）的病灶内曲安奈德。结果：患者为一名27岁女性，在既往15次鼻部手术后出现双侧前庭狭窄和左侧鼻孔完全阻塞。第1阶段后，双侧气流在临床上得到改善，3个月检查时前庭组织更柔软且灌注更好。第2阶段采用了人中嵴推进皮瓣、肋软骨和耳软骨移植物以及颊黏膜移植物。在超过3年时，临床评估显示鼻腔气流和美学轮廓保持稳定，狭窄未复发，且无需进一步支撑。结论：该单例病例提示，分阶段手术策略联合结构化的生物制剂和支撑方案可能是一种有用的挽救选择；需要更多病例和客观功能评估来确认其价值。证据等级：4（治疗性）。

英文摘要

Severe nasal vestibular stenosis is an increasingly recognized iatrogenic complication of cosmetic rhinoplasty. Multiply-revised cases are particularly difficult to manage because previous procedures may compromise the vestibular microcirculation, whereas prolonged stenting alone risks ischemic restenosis. We describe an individualized, staged multimodal salvage approach and illustrate it in a single patient. Stage 1 reopened the obstructed vestibule with scar excision, a local skin flap, and a custom stent, followed by ∼3 months of cold atmospheric plasma (CAP) and monthly intralesional platelet-rich plasma (PRP) intended to condition the scar bed and improve tissue pliability. Stage 2 provided definitive aesthetic reconstruction tailored to the anatomical defects, supported by a 12-month adjunctive regimen of tapered nasal stenting, peri-incisional PRP, a CAP cycle alternating antimicrobial and wound-healing modes, and intralesional triamcinolone acetonide at escalating concentrations (5-40 mg/mL). The patient was a 27-year-old woman with bilateral vestibular stenosis and complete left nostril obstruction after 15 previous nasal procedures. After Stage 1, bilateral airflow was clinically improved and the vestibular tissue was softer and better perfused on examination at 3 months. Stage 2 employed a philtral advancement flap, costal and auricular cartilage grafts, and a buccal mucosal graft. At more than 3 years, nasal airflow and aesthetic contour remained stable on clinical assessment, with no recurrence of stenosis and no further stenting. This single case suggests that a staged surgical strategy combined with a structured biologic and stenting regimen may be a useful salvage option; further cases and objective functional assessment are required to confirm its value. Level of Evidence: 4 (Therapeutic).