Chen P K, Yeow V K, Noordhoff M S, Chen Y R
Craniofacial Center, Children's Hospital, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ann Plast Surg. 1999 Feb;42(2):149-53.
The symmetry of the alar base and the nasal floor is very important in achieving a satisfactory result in primary lip and nasal reconstruction during cleft lip repair. The skeletal base of the nasal pyramid is usually hypoplastic even in incomplete clefts. A periosteal pocket filled with Surgicel can facilitate blood clot formation and can theoretically stimulate bone formation, thereby improving the asymmetry of the bone base. To test this hypothesis, a prospective study was performed in 64 primary lip repairs by comparing the effect of subperiosteal nasal floor augmentation with Surgicel. From February 1989 to June 1993, 64 patients with incomplete cleft lips (excluding occult cleft lip and complete clefts with Simonart's band) were operated by the same surgeon. The patients were divided randomly into two groups. One group had subperiosteal nasal floor augmentation with Surgicel and the other group did not. The lip repair was a rotation-advancement cheiloplasty with primary closed rhinoplasty of the tip and ala. In the first group, a subperiosteal pocket was created under the cleft alar base and the nasal floor. The pocket was filled with Surgicel up the point where the level of the alar base and the nasal floor was symmetrical with the noncleft side. The control group underwent a similar procedure, less the creation of the subperiosteal pocket and the use of Surgicel. All patients were followed for at least 3 years and their photographs were used to compare and analyze the results of their nasal correction. Critical attention was paid to the symmetry of their nasal floor and alar base. The results were evaluated by at least two plastic surgeons for consistency. The data indicate that the control group showed a higher number of subjects with asymmetry (10 of 32) compared with the study group (8 of 32). However, there was no statistical significance to the findings. Two patients in the study group who received Surgicel developed hypertrophic lip scars. This study, although unable to determine statistically the contributory affect of Surgicel in primary nasal reconstruction, does show a possible benefit from the use of osteogenic materials in the primary management of the deficient nasal floor. Hypertrophic scars developed by 2 patients in the study group may point to a possible soft-tissue reaction to the use of Surgicel in primary lip and nasal repair.
在唇裂修复术中进行一期唇鼻重建时，鼻翼基部和鼻底的对称性对于获得满意的效果非常重要。即使在不完全性唇裂中，鼻锥体的骨骼基部通常也发育不全。用 Surgicel 填充的骨膜下袋可促进血凝块形成，理论上还可刺激骨形成，从而改善骨基部的不对称性。为验证这一假设，对 64 例一期唇裂修复术患者进行了一项前瞻性研究，比较了骨膜下鼻底用 Surgicel 填充的效果。1989 年 2 月至 1993 年 6 月，64 例不完全性唇裂患者（不包括隐性唇裂和伴有西蒙氏带的完全性唇裂）由同一位外科医生进行手术。患者被随机分为两组。一组进行骨膜下鼻底用 Surgicel 填充，另一组不进行。唇裂修复采用旋转推进式唇成形术，并对鼻尖和鼻翼进行一期闭合鼻成形术。在第一组中，在患侧鼻翼基部和鼻底下方创建一个骨膜下袋。用 Surgicel 填充该袋，直至鼻翼基部和鼻底的水平与非患侧对称。对照组进行类似手术，但不创建骨膜下袋和不使用 Surgicel。所有患者均随访至少 3 年，并使用他们的照片来比较和分析鼻矫正的结果。重点关注鼻底和鼻翼基部的对称性。结果由至少两名整形外科医生进行评估以确保一致性。数据表明，与研究组（32 例中有 8 例）相比，对照组中不对称的受试者数量更多（32 例中有 10 例）。然而，这些发现没有统计学意义。研究组中有两名接受 Surgicel 治疗的患者出现了肥厚性唇部瘢痕。本研究虽然无法从统计学上确定 Surgicel 在一期鼻重建中的作用，但确实显示了在一期处理鼻底缺损时使用成骨材料可能带来的益处。研究组中有两名患者出现肥厚性瘢痕，这可能表明在一期唇鼻修复中使用 Surgicel 可能会引起软组织反应。
