功能性鼻整形术中鼻部皮肤受损：文献综述及临床管理方案建议

文献信息

中文摘要

鼻整形术是面部外科中最复杂的手术之一，尤其是在修复手术的背景下。鼻部皮肤软组织包膜（SSTE）的完整性是美学和功能结局的关键因素，该结构的血管受损可能导致最令人担忧的并发症之一：皮肤坏死。本综述旨在综合现有证据，探讨鼻整形术后鼻部皮肤受损处理中的危险因素和治疗策略。在PubMed和Embase中进行了文献综述，以识别描述鼻整形术后皮肤坏死的研究。确定的主要危险因素为修复手术、吸烟和皮瓣的过度削薄。现有文献提示，早期启动局部硝酸甘油、高压氧治疗和己酮可可碱等治疗可能在部分病例中改善组织挽救。提出了一套整合术前评估以及术中、术后早期管理算法的临床方案。早期识别高危患者并实施标准化的多模式方法，可能有助于在复杂鼻整形手术中优化皮肤活力。

英文摘要

Rhinoplasty is one of the most complex procedures in facial surgery, particularly in the context of revision surgery. The integrity of the nasal skin-soft tissue envelope (SSTE) is a critical factor for both aesthetic and functional outcomes, and vascular compromise of this structure may lead to one of the most feared complications: cutaneous necrosis. The aim of this review is to synthesize the available evidence regarding risk factors and therapeutic strategies in the management of compromised nasal skin following rhinoplasty. A literature review was conducted in PubMed and Embase to identify studies describing cutaneous necrosis following rhinoplasty surgery. The main risk factors identified were revision surgery, smoking, and aggressive thinning of the cutaneous flap. The available literature suggests that early initiation of therapies such as topical nitroglycerin, hyperbaric oxygen therapy, and pentoxifylline may improve tissue salvage in selected cases. A clinical protocol integrating preoperative assessment and an early intraoperative and postoperative management algorithm is proposed. Early identification of high-risk patients and the implementation of a standardized multimodal approach may help optimize skin viability in complex rhinoplasty procedures.