小伙额头上“种”鼻子 生长9个月成活
A young man "grows" a nose on on his forehead after nine months
文章来源: 东南网 于 2013-09-25
Source: Southeast Network on 2013-09-25
http://www.wenxuecity.com/news
经过近9个月的生长，鼻子“种植”成功
After nearly nine months of growth, the nose, the "planting" successful
取划线处进行移植
Line sketched on the edges of the graft will be transplanted
种花种草很常见，但“种”鼻子你见过吗，而且还是在人的额头上“种”？
福建医科大学附属协和医院的医生就花了近9个月时间，为在车祸中毁了鼻子的泉州小伙小连（化名）种“活”了一个鼻子。
这个额头上“种”出的鼻子，鼻孔、鼻柱、鼻粘膜一应俱全，还有完好的血供。
据协和医院整形外科主任郭志辉主任医师介绍，这个漫长、复杂的鼻子整形手术叫“鼻预构术”，小连做的这种手术在全国鼻整形中尚无先例。
车祸夺走了帅小伙的鼻子 鼻中隔软骨因感染被溶解
22岁的泉州小伙小连，浓眉大眼，长相还挺帅气。但去年8月，他和父亲发生了一场车祸。
车祸中，小连的鼻子受了严重外伤，左侧鼻翼没了，鼻柱也被毁了一部分。经过及时治疗，小连的身体并没有什么大碍，但由于家庭经济等原因，他并没有立即进行鼻整形手术。
不过，后来的感染加重了鼻子的缺损程度，小连的鼻中隔软骨慢慢被溶解了，导致严重鼻中隔缺损。
车祸和感染导致小连的鼻子明显畸形，不仅外观受到影响，由于狭窄、残存鼻柱右移等多种问题引起的通气过敏、气喘等毛病也随之而来。
车祸后，为了掩饰鼻子的缺陷，小连就戴起了口罩，整个人也变得自卑和消沉起来。
今年年初，考虑再三，小连在跑了多家医院后，最终找上协和医院整形外科询问治疗方法。
医生在患者额头上“种”鼻子 取肋骨软骨再造鼻柱
经过仔细检查，全国鼻整形亚专科常委、协和医院整形外科主任郭志辉主任医师发现，小连的鼻子缺损，无法采用传统的鼻再造术进行修补。
同时，郭主任的治疗团队查阅了大量的文献资料，都没有找到适合小连这种情况的鼻子再造术法。由于没有先例可以参考，在50多年整形经验的积淀下，郭主任的团队想做一个大胆的挑战。
经过慎重评估后，郭主任给小连制定了鼻整形手术，打算在小连的额部“种植”一个预构鼻，等达到“移植”手术指征后再进行预构鼻的转移修补。该手术分七期进行，历时一年左右。
小连同意全力配合治疗，郭主任便开始了漫长的“种”鼻之旅。
第一期手术扩张额部皮肤，把皮肤扩张器植入额部的皮肤内，并定期注水使其逐渐膨胀，以促进额部皮肤扩张，为鼻部再造提供皮肤。
鼻部新皮肤长好就耗了3个多月。传统手术一般是在第一期手术后，就将额部新增长的皮肤以皮瓣的形式转移覆盖到鼻部，进行鼻部再造术。如果小连采用这种传统术法，由于鼻中隔严重受损，以后鼻子极易塌陷变形。
于是，第二步郭主任进行了软骨支架预构，取小连的肋骨软骨，进行了鼻柱（包括鼻中隔、鼻小柱）再造，当天耗时4个多小时，终于完成这个鼻支架预构手术。
如何养活这个软骨，让鼻中隔拥有完好的血供，这是决定手术成败的难点。而给鼻中隔提供血液循环的粘膜仅为薄薄的1毫米。可以想象手术之精细。
大约又过了3个月，人工制造的粘膜终于发挥作用“养活”了鼻中隔。接下来，就是两侧鼻孔的成形手术，先进行右侧鼻孔成形，然后是左侧鼻孔成形。
每一个环节步步紧扣，任何一个环节的失败，都将影响最后的效果，因此必须严密观察血供情况，其中大量应用了皮瓣、包膜瓣等技术。
在经历了近9个月时间后，小连额头上的鼻子终于“种植”成功了。
“种”的鼻子成活了 测完动脉走向就能移植
郭主任说，小连的鼻子经过生长，目前已达到了可以“移植”的手术指征。
接下来要进行预构鼻转移手术，难度并不大。不过，在转移手术前，还需要测定小连额部给鼻子提供血供的动脉—滑车动脉走向，然后确定具体的预构鼻转移方案。
最后的鼻子转移并不是整个进行移植，而是局部进行移植，取新长鼻子的下半部（如图），将这部分鼻子翻转覆盖在缺损的鼻部。翻转鼻子不可过分分离，还要与额部皮肤相连以获取血液供应，否则会影响转移鼻子的成活，因此选择在额部种鼻子的原因也在于此。
预构鼻转移手术在近期很快就能进行，预计手术时长为2.5-3个小时。
这个手术结束后，还要进行“断蒂手术”，顾名思义，即通过鼻子周围血供可以“养活”转移的鼻子后，就可以断掉移植鼻子与额部之间的血供连接，多余皮肤仍铺回原来额部缝合。
最后一步，就是进行“微雕”，让鼻子更加自然。至此，一个完美的鼻部再造手术就完成了。
小连说，最近他的心情已经越来越急迫了。正常的鼻子缺损了，额头又长了一个“鼻子”，这让他每次出门都要全副武装，口罩、棒球帽这样的装备一样都不能少。“希望手术快点结束，我能快点甩掉口罩，恢复自由呼吸。”
郭主任说，鼻子再造的整形理念其实由来已久，早在1998年，从事组织工程医学研究的专家就探索“老鼠背上长人耳朵”。而鼻预构术是在传统理念方法上的再创新，这样的鼻整形手术在国内尚属首例。经过此次的摸索，下个病人进行鼻预构术直接分三步就能完成了。
福州新闻网讯　随着科技的进步，培育人造器官已不再是一个梦想。近日，福建医科大学附属协和医院为因车祸鼻子受伤腐烂的患者在额头上培育出一个人造鼻子，如果一切顺利进行，下一步，这个人造鼻子将从额头上取下，而后移植到患者面部。据悉，在额头上进行鼻预构手术在国内尚属首例。
去年8月，泉州小伙小连(化名
遭遇车祸鼻子受伤，起先以为只是小伤，并没有放在心上，最终导致鼻子慢慢腐烂。今年初，在家人的劝说下，小连决定来到福建医科大学附属协和医院做整形手术。
24日，记者在福建医科大学附属协和医院见到了小连的主治医生郭志辉。据郭医生介绍，小连因鼻中隔缺损，医院无法应用传统的方法进行鼻再造手术，经讨论，决定进行鼻预构手术。
郭医生表示，鼻预构手术就像是在患者的额头上“种”出一个新的鼻子来，“等到这个鼻子长好以后，再通过移植手术将培育出来的鼻子代替原来受损的鼻子。”
经过几个月的治疗，目前手术已完成4个主要步骤，包括额部皮肤扩张、软骨支架预构和左右两侧鼻孔成型。“这个手术已经成功完成了80%，剩下的预构转移、断蒂、微雕，三个步骤是我们经常做的手术，没有难度。”郭医生说。
记者了解到，在额头进行鼻预构手术在国内尚属首例。另据外媒报道，今年初，英国伦敦大学学院的科学家曾在一名因皮肤癌失去鼻子的男性患者手臂上培育出一个人造鼻子并移植到其面部。
Flowers and grass are common, but the " kind " nose you seen it , but also in people 's forehead "species" ?
Union Hospital of Fujian Medical doctors spent nearly nine months time, as in a car accident ruined nose Quanzhou guy even a small ( a pseudonym ) kind of "live" a nose.
The forehead "kind of" out of the nose , nostrils, nasal column , nasal readily available, there intact blood supply .
According to Union Hospital, director of plastic surgery Kwok chief physician , this lengthy , complex nose plastic surgery called " prefabricated nose surgery " , small even in the country to do this surgery Rhinoplasty is no precedent .
Accident took handsome nose septal cartilage is dissolved due to infection
22 -year-old guy Quanzhou small even , thick eyebrows , looks quite handsome. But last August , he and his father had a car accident .
Car accident , even a small nose suffered serious injuries, the left nose is gone, also destroyed part of the nasal column . After timely treatment , even a small body and no serious problem , but because of family economic and other reasons, he did not immediately rhinoplasty .
However, the subsequent infection of the nose increased deficit , even a small septal cartilage slowly being dissolved , resulting in severe septal defect .
Accidents and infections lead to even a small nose obvious deformity, only the appearance of affected due to narrow right column remnants of nasal ventilation and other problems caused by allergies , asthma and other illnesses also follow.
After the accident , in order to cover the nose defects even on the DAI Qi small masks , the people have become self-esteem and depression together .
Earlier this year, think twice, even a small number of hospitals in the run , the final look on Plastic Surgery , Union Hospital, asking treatment.
Doctors on the forehead of the patient , " graft " to take rib cartilage nose reconstruction columella
After careful examination , the Standing Committee of the National nose surgery subspecialties , Union Hospital, director of plastic surgery Kwok chief physician found that even a small defect on the nose , you can not use the traditional nasal reconstruction surgery to repair .
Meanwhile, Director Guo 's treatment team access to a large number of documents , did not find even this situation for small nose reconstruction method . Since there is no precedent can refer to the accumulation of 50 years of experience in plastic surgery , the Director Guo 's team wanted a bold challenge.
After careful evaluation, Director Guo give small even developed rhinoplasty , intended connection in a small forehead " planting " a prefabricated nose, etc. to achieve "transplanted" indications for surgery performed after the transfer of prefabricated nose repair. The surgery in seven phases, which lasted about a year .
Small even agreed to fully cooperate with treatment, Director Guo began a lengthy "species" nose trip.
The first phase of expansion of the forehead skin surgery , the tissue expander implanted inside the skin of the forehead , and regular water it gradually expanded to facilitate the forehead skin expansion for nasal reconstruction provides the skin.
Nasal new skin grows well on the consumption of more than three months. Traditional surgery is generally in the first period after surgery , it will be a new growth forehead flap of skin in the form of transfers to cover the nose for nasal reconstruction . Even if the small traditional technique using this method , since the nasal septum severely damaged after the collapse easily deformed nose .
Thus , the second step Director Guo were prefabricated cartilage , even take a small rib cartilage for nasal column ( including the nasal septum , nasal columella ) recycling , the day took more than four hours , and finally completed the nasal stents prefabricated surgery.
How to feed the cartilage , so that the nasal septum has a good blood supply, which is to determine the success of surgery difficult . The blood circulation to the nasal mucosa provides only a thin 1 mm . Imagine surgery fine .
Then, after about three months, the artificial mucosa finally play " feed " the nasal septum . Next, the forming operation is both nostrils , the first for forming the right nostril , the left nostril and shape.
Every aspect of every step closely , any link failure will affect the final results, it is necessary to closely observe the blood supply , including a large number of applications flap envelope flap techniques.
After nearly nine months , a small nose and finally even his forehead , " planting " a success.
"Species" survival of the nose to be able to test finished arterial graft
Director Guo said that the small nose even after growth has now reached that can be "transplanted" indications for surgery .
Next step is to carry out the transfer of prefabricated nasal surgery , the difficulty is not great. However, the transfer before surgery , you also need to determine even a small nose and forehead provide arterial blood supply - arteries to tackle , and then determine the specific transfer programs prefabricated nose .
The final transfer of the nose is not the whole transplant , but the partial transplant , take the lower half of the new long nose ( Figure ) , this part of the nose, nasal flip cover the defect . Flip nose not too isolated , but also connected with the forehead skin to get the blood supply , otherwise it will affect the survival of the transfer nose , so choose the kind of nose, forehead reason also here.
Transfer of prefabricated nasal surgery can be carried out quickly in the near future , it is expected surgery duration of 2.5 to 3 hours.
After this surgery , but also for " pedicle operation" , by definition, that is, through the blood supply around the nose can " feed " the transfer of the nose , you can cut off the nose and the forehead between the transplanted blood supply connection , the excess skin is still Shop back to the original frontal suture.
The final step is a " miniature ", so that the nose more natural. Thus, a perfect nose reconstruction surgery is complete.
Small even said that recently his mood has become increasingly urgent. Defect in the normal nose , forehead and long a "nose" , which makes him out to be armed each , masks, baseball caps such equipment like Less . "I hope the surgery end quickly , I was able to quickly get rid of the mask to restore free breathing ."
Director Guo said , nose plastic recycling concept is actually a long time , back in 1998 , engaged in medical research tissue engineering experts to explore the "mouse ears back, big man ." The prefabricated nasal surgery in the traditional concept of methodological re-innovation, such as rhinoplasty first in the country . After this exploration, the next patient prefabricated nasal surgery can be done in three steps directly .
Fuzhou News Network With advances in technology , foster artificial organs is no longer a dream. Recently, Union Hospital of Fujian Medical University, nose injured in a car accident on his forehead were rotting breed an artificial nose, and if all goes well for the next step, this artificial nose is removed from the forehead , and then transplanted to the patient's face . It is reported that the nose on the forehead prefabricated surgery first in the country .
Last August, Quanzhou little guy even ( a pseudonym ) had an accident and injured his nose , at first thought it was only minor injuries and did not mind, eventually leading to the nose slowly decaying . Earlier this year, persuaded his family , small even decided to come to Union Hospital of Fujian Medical University to do plastic surgery.
On the 24th , the reporter in Union Hospital of Fujian Medical University, saw the little doctor Kwok connected . According to Guo doctors, even a small septal defect because the hospital can not apply traditional methods nasal reconstruction surgery , after discussion , decided to conduct prefabricated nasal surgery.
Dr. Guo said prefabricated nose surgery is like the patient's forehead "kind of" a new nose , the " wait until well after the long nose , and then out through the transplant surgery will foster the nose instead of the original damaged nose. "
After several months of treatment, the current operation has completed four major steps, including the forehead skin expansion , prefabricated cartilage left and right sides of the nose shape. "This operation has been successfully completed 80 % of the remaining prefabricated transfer pedicle , miniature , three steps that we often do the surgery , there is no difficulty ." Dr. Guo said.
Reporters learned that, in the forehead for prefabricated nose surgery first in the country . According to foreign media reports earlier this year, scientists at University College London, worked in a losing cause skin cancer in men with arm nose breed an artificial nose and migrate to their face.
net assisted translation
Fujian University - Union Hospital
