University of Minnesota Academic Health Center, School of Dentistry, Cleft Palate and Craniofacial Clinics, Minneapolis, Minnesota.
Semin Plast Surg. 2008 May;22(2):90-103. doi: 10.1055/s-2008-1063568.
The augmentation-reduction principle is becoming pervasive in nasal surgery. Rhinoplasty surgeons have discovered that nasal skin does not consistently contract. Therefore, nasal augmentation is an increasingly accepted technique, and grafts are required. Autogenous cartilage is the grafting material of choice. There are drawbacks to autogenous material, especially in secondary rhinoplasty patients who are often graft-depleted. Cartilage grafts may cause unsightly irregularities over time. Therefore, an interest in alternative soft tissue substitutes has developed. AlloDerm is freeze-dried acellular cadaver dermis. AlloDerm acts as a filler to expand portions of the nasal skin envelope to balance the overresected nose and adhere to the augmentation-reduction principle. AlloDerm facilitates touch-ups, especially in the author's own personal patients. It is soft, thin, and pliable and can be placed under very thin skin. AlloDerm obviates the necessity for graft harvest. It is safe in that it can eliminate the risk of donor-site problems for dorsal onlays such as cranial bone or rib grafts. It is natural and acts as an excellent camouflage graft when used as padding over a cartilage graft. It is incorporated into the surrounding tissue and does not develop unsightly irregularities over time. Extrusion is rare. It does not shift over time. It is especially useful in donor-site-depleted patients. Overcorrection is absolutely necessary because a portion of the implanted AlloDerm is always absorbed. Resorption is most common over the bony dorsum with about 20 to 30% of the graft absorbing. Resorption is disappointing for the patient and frustrating for the surgeon. Absorption does not seem to relate to the number of layers used. No graft absorption has been noted after 1 year. Therefore, it is safe to assume that the patient has a stable result from the AlloDerm graft after 1 year, and no further change should be anticipated. It is easy to use. The advantages and caveats should be kept in mind when evaluating a patient for a dorsal graft.
增强-减少原则在鼻外科中越来越普遍。鼻整形术医生发现，鼻皮肤并不总是收缩。因此，鼻增大术是一种越来越被接受的技术，需要进行移植物。自体软骨是首选的移植物材料。自体材料有其缺点，尤其是在经常移植物耗尽的二次鼻整形患者中。随着时间的推移，软骨移植物可能会导致难看的不规则。因此，人们对替代软组织替代品产生了兴趣。AlloDerm 是冻干的无细胞尸体真皮。AlloDerm 充当填充物，扩大部分鼻皮瓣的包膜，以平衡过度切除的鼻子，并遵循增强-减少原则。AlloDerm 便于进行修补，特别是在作者自己的患者中。它柔软、薄且柔韧，可以放置在非常薄的皮肤下。AlloDerm 避免了移植物采集的必要性。它是安全的，因为它可以消除颅骨或肋骨移植物等背侧覆盖物的供体部位问题的风险。它是天然的，并且在用作软骨移植物的填充材料时是一种极好的伪装移植物。它被纳入周围组织中，随着时间的推移不会出现难看的不规则。挤出很少见。随着时间的推移，它不会移动。它在供体部位耗竭的患者中特别有用。绝对需要过度矫正，因为一部分植入的 AlloDerm 总是被吸收。吸收最常见于骨性背侧，约 20%至 30%的移植物吸收。吸收对患者和外科医生来说都令人失望。吸收似乎与使用的层数无关。1 年后未观察到移植物吸收。因此，可以安全地假设患者在 1 年后从 AlloDerm 移植物中获得稳定的结果，并且不应预期进一步的变化。它易于使用。在评估患者是否需要背侧移植物时，应牢记其优缺点。
