Beverly Hills, Calif. From the ROX Center.
Plast Reconstr Surg. 2014 May;133(5):1087-1096. doi: 10.1097/PRS.0000000000000119.
Costal cartilage grafts are used more frequently in secondary rhinoplasty. However, these procedures result in patients that require further revision operations that are not trivial. The purpose of this study was to assess the outcomes of reconstructive rhinoplasty performed on patients with a history of prior secondary or tertiary rhinoplasty using autogenous costal cartilage grafts.
A retrospective review was conducted of tertiary rhinoplasty procedures. Outcomes of interest included the indications for the revision operation; revision rate following the tertiary costal cartilage revision; whether or not the use of costal cartilage grafts for the reconstructive rhinoplasty was a planned event; and perioperative incidents such as infection, structural collapse, and scarring requiring further surgery.
Forty-six patients met inclusionary criteria. The revision rate following tertiary rhinoplasty performed by the primary author was found to be 24 percent (11 of 46). The reasons for these revision operations were nasal airway obstruction (n = 6), aesthetic dissatisfaction (n = 4), and infection (n = 1). Outcomes of the revisions were satisfactory, with no adverse complications requiring further surgery.
Reconstructive rhinoplasty may be required in patients who have undergone previous costal cartilage grafting for secondary rhinoplasty. These revision operations can be performed successfully to help patients achieve both improved function and aesthetic results but have a higher than usual revision rate themselves. The revisions of these operations can be managed with standard revision operations that result in satisfactory outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
肋软骨移植在二次鼻整形术中应用更为频繁。然而，这些手术导致患者需要进一步的修正手术，而且这些手术并不简单。本研究的目的是评估使用自体肋软骨移植对有既往二次或三次鼻整形术病史的患者进行重建性鼻整形术的结果。
对三次鼻整形手术进行了回顾性研究。感兴趣的结果包括修正手术的适应证；三次肋软骨修正后的修正率；重建性鼻整形术是否使用肋软骨移植是否是一个计划事件；以及围手术期事件，如感染、结构塌陷和需要进一步手术的瘢痕形成。
46 名患者符合纳入标准。主要作者进行的三次鼻整形术后修正率为 24%（46 例中有 11 例）。这些修正手术的原因是鼻气道阻塞（n=6）、美学不满意（n=4）和感染（n=1）。修正手术的结果令人满意，没有需要进一步手术的不良并发症。
对于因二次鼻整形术而接受过肋软骨移植的患者，可能需要进行重建性鼻整形术。这些修正手术可以成功进行，帮助患者获得改善的功能和美学效果，但自身的修正率高于通常水平。这些手术的修正可以通过标准的修正手术来管理，结果令人满意。
临床问题/证据水平：治疗，IV。
