Sharma Ayushman, Janus Jeffrey, Diggelmann Henry R, Hamilton Grant S
Department of Otorhinolaryngology, Division of Facial Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Ann Otol Rhinol Laryngol. 2015 Jun;124(6):425-9. doi: 10.1177/0003489414565002. Epub 2014 Dec 22.
Several techniques are described in the literature for nasal septal perforation repair. Most of these involve interposition grafts in conjunction with local pedicled mucosal flaps. The following article describes our experience using acellular dermis as a bioscaffold to support the regrowth of nasal septal mucosa by secondary intention.
Retrospective chart review of all patients who underwent repair of nasal septal perforations by the senior author using acellular dermis placed between the 2 sides of the perforation and covered with silastic splints to allow for mucosalization.
Thirteen patients underwent nasal septal perforation repair using this technique. All perforations repaired were under 2 cm in greatest dimension. Two-thirds of patients had complete closure of the perforation upon initial use of bioscaffolding technique. The remaining third achieved near-total closure with bioscaffolding technique and were able to be completely closed with a single additional procedure.
Acellular dermis offers an alternative to most currently described complex flaps. The method can be used in patients with defects less than 2 cm, but initial data suggest caution when using in those with wound healing impediments. This technique is also an excellent choice for patients with multiple small septal perforations.
文献中描述了几种鼻中隔穿孔修复技术。其中大多数涉及插入移植物并结合局部带蒂黏膜瓣。以下文章描述了我们使用脱细胞真皮作为生物支架，通过二期愈合来支持鼻中隔黏膜再生的经验。
对资深作者使用脱细胞真皮置于穿孔两侧并覆盖硅橡胶夹板以实现黏膜化的方式进行鼻中隔穿孔修复的所有患者进行回顾性病历审查。
13例患者使用该技术进行了鼻中隔穿孔修复。所有修复的穿孔最大尺寸均小于2厘米。三分之二的患者在初次使用生物支架技术时穿孔完全闭合。其余三分之一的患者通过生物支架技术实现了近乎完全闭合，并能够通过一次额外手术完全闭合。
脱细胞真皮为目前描述的大多数复杂皮瓣提供了一种替代方案。该方法可用于缺损小于2厘米的患者，但初步数据表明，在伤口愈合有障碍的患者中使用时需谨慎。对于有多个小鼻中隔穿孔的患者，该技术也是一个极佳选择。
