Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2013 Oct;132(4):780-786. doi: 10.1097/PRS.0b013e31829ad339.
Secondary open rhinoplasty is a complex topic with many hazards. Although there has been much discussion in the literature about what transcolumellar scar design creates the best aesthetic result, placement of the scar in a previously opened nose has not been widely discussed. In light of the outstanding blood supply to the nose, and often the desire to reposition the transcolumellar scar, the senior surgeon (R.J.R.) has ignored prior incisions in the columella and has chosen to place the incision in the best location for the current operative plan.
This article retrospectively reviewed 100 secondary rhinoplasty patients who had undergone two open procedures with different transcolumellar incisions performed by the senior surgeon from 2000 to 2010. Scar quality was graded preoperatively and postoperatively by three reviewers on a four-point scale from imperceptible to poor scar.
Scar quality averaged 1.68 preoperatively and 1.61 postoperatively, indicating scar quality between imperceptible and barely perceptible. There was no skin bridge necrosis in the series, no infection, and no wound breakdown. Patient satisfaction was noted to be high overall.
Anatomical studies have previously shown the safety of the transcolumellar incision in rhinoplasty. This article has shown the safety of ignoring prior incisions in the columella and basing the new scar location solely on where the surgeon feels is ideal. Although caution should always be used when creating possibly devitalized skin bridges, this study lends weight to the argument that one can safely ignore prior incision patterns in this aesthetically important and well-vascularized area.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
二次开放式鼻整形术是一个复杂的课题，存在诸多风险。尽管文献中已经讨论了很多关于哪种鼻中隔瘢痕设计能产生最佳美学效果的问题，但对于瘢痕在已切开的鼻子中的位置，尚未广泛讨论。鉴于鼻子的血液供应非常丰富，而且通常希望重新定位鼻中隔瘢痕，资深外科医生（RJR）忽略了鼻中隔上的先前切口，并选择将切口置于最符合当前手术计划的位置。
本文回顾性分析了 100 例由资深外科医生于 2000 年至 2010 年施行的两次开放式鼻整形术且采用不同鼻中隔切口的二次鼻整形术患者。三位评估者采用四级评分法，对术前和术后的瘢痕质量进行评估，评分范围从不可见到瘢痕较差。
瘢痕质量平均术前为 1.68，术后为 1.61，表明瘢痕质量处于不可见和勉强可见之间。该系列中无皮肤桥坏死、感染和伤口裂开。总体上患者满意度较高。
解剖学研究先前已经证明了鼻中隔切口在鼻整形术中的安全性。本文还表明，忽略鼻中隔上的先前切口并仅根据外科医生认为理想的位置来确定新的瘢痕位置是安全的。尽管在创建可能失活的皮肤桥时应始终谨慎，但该研究支持这样的论点，即在这个美学上重要且血供丰富的区域，可以安全地忽略先前的切口模式。
临床问题/证据水平：治疗性，IV。
