扩张额部皮瓣中同侧与对侧血管蒂用于鼻翼坏死：哪种更好？

文献信息

中文摘要

目的： 探讨应用扩张的旁正中额部皮瓣联合自体肋软骨支架重建由透明质酸注射导致的鼻翼坏死缺损的疗效，并比较同侧与对侧血管蒂设计的临床差异。
方法： 在这项回顾性研究（2021年5月至2024年8月）中，21例患者接受了分期重建：组织扩张、基于同侧（n=10）或对侧（n=11）血管蒂的皮瓣转移联合软骨支架，随后进行血管蒂断蒂和修整。采用ROE和NOSE量表以及盲法照片评估来评价结果。
结果： 所有皮瓣均完全成活。术后ROE显著升高，NOSE显著降低（均P < 0.05）。组间比较显示效应量可忽略不计且置信区间较宽，主要结局（ROE改善）的事后检验效能仅为9%。未观察到统计学显著差异，但该研究效能不足，无法检测等效性。
结论： 扩张的旁正中额部皮瓣联合肋软骨鼻成形术是重建此类医源性鼻翼缺损的有效策略。我们初步的、效能不足的比较提示，两种血管蒂设计均可获得满意结果；然而，这些发现并未确立等效性，血管蒂选择应根据患者解剖结构和生物力学考虑进行个体化。
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英文摘要

OBJECTIVE: To investigate the outcomes of utilizing an expanded paramedian forehead flap combined with an autologous costal cartilage framework for reconstructing alar necrosis defects caused by hyaluronic acid injection, and to compare the clinical differences between ipsilateral and contralateral pedicle designs.
METHODS: In this retrospective study (May 2021-August 2024), 21 patients underwent staged reconstruction: tissue expansion, flap transfer with cartilage framework based on ipsilateral (n=10) or contralateral (n=11) pedicles, followed by pedicle division and revision. Outcomes were assessed using ROE and NOSE scales and blinded photographic evaluation.
RESULTS: All flaps survived completely. Postoperative ROE increased and NOSE decreased significantly (both P < 0.05). Between-group comparisons demonstrated negligible effect sizes with wide confidence intervals, and post hoc power for the primary outcome (ROE improvement) was only 9%. No statistically significant differences were observed, but the study was underpowered to detect equivalence.
CONCLUSION: The expanded paramedian forehead flap combined with costal cartilage rhinoplasty is an effective strategy for reconstructing this type of iatrogenic alar defect. Our preliminary, underpowered comparison suggests that both pedicle designs can yield satisfactory outcomes; however, these findings do not establish equivalence, and pedicle choice should be individualized based on patient anatomy and biomechanical considerations.
LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .