Rezaeian Farid, Gubisch Wolfgang, Janku Dirk, Haack Sebastian
Stuttgart, Germany and Zurich, Switzerland.
From the Department of Facial Plastic Surgery, Marienhospital Stuttgart and the Department of Plastic Surgery and Hand Surgery, University of Zurich.
Plast Reconstr Surg. 2016 Aug;138(2):374-382. doi: 10.1097/PRS.0000000000002412.
Severe septal deformations require adequate treatment to restore shape and function using extracorporeal septoplasty. Because it has been criticized for being technically demanding to execute and has increased risk for aesthetic complications, the authors have developed two new suture techniques for refixation of the neoseptum.
A retrospective analysis of multisurgeon consecutive extracorporeal septoplasties performed from January of 2014 to December of 2014 was conducted at a single institution using the criss-cross or transcutaneous transosseous cerclage suture (group 1) compared with fixation at the upper lateral cartilages only (group 2).
One hundred ten extracorporeal septoplasties were performed in 110 patients over 12 months. Group 1 consisted of 58 patients (53 percent), whether receiving the criss-cross [12 patients (21 percent)] or the transcutaneous transosseous cerclage suture [46 patients (79 percent)], and group 2 consisted of 52 patients (47 percent). The median follow-up was 11 months (range, 6 to 16 months). Operative revision because of complications at the dorsum or the keystone area had to be performed in no case in group 1 and in five cases (9.6 percent) in group 2, resulting in a statistically significant difference between the two groups (p = 0.0212). There were no complications such as bleeding or infection observed in any of the 110 cases.
To facilitate and to reduce the complication rate after extracorporeal septoplasty, the authors have developed the criss-cross and transcutaneous transosseous cerclage suture to overcome the important and technically demanding reimplantation of the neoseptum. Thus, the authors believe that these new operative techniques are safe and reproducible procedures that may take a permanent place among extracorporeal septoplasty procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
严重的鼻中隔畸形需要采用体外鼻中隔成形术进行适当治疗，以恢复形态和功能。由于该手术因操作技术要求高且美学并发症风险增加而受到批评，作者开发了两种用于新鼻中隔重新固定的新缝合技术。
在单一机构对2014年1月至2014年12月连续进行的多医生体外鼻中隔成形术进行回顾性分析，将使用十字交叉或经皮穿骨环扎缝合的患者分为一组（第1组），仅在上外侧软骨处固定的患者分为另一组（第2组）。
在12个月内对110例患者进行了110例体外鼻中隔成形术。第1组有58例患者（53%），其中接受十字交叉缝合的有12例（21%），接受经皮穿骨环扎缝合的有46例（79%）；第2组有52例患者（47%）。中位随访时间为11个月（范围6至16个月）。第1组无一例因鼻背或关键区域并发症而进行手术修复，第2组有5例（9.6%），两组之间差异有统计学意义（p = 0.0212）。110例病例中均未观察到出血或感染等并发症。
为了便于体外鼻中隔成形术操作并降低并发症发生率，作者开发了十字交叉和经皮穿骨环扎缝合技术，以克服新鼻中隔重新植入这一重要且技术要求高的问题。因此，作者认为这些新的手术技术是安全且可重复的，可能会在体外鼻中隔成形术方法中占据永久地位。
临床问题/证据级别：治疗性，III级。
