Zelken Jonathan, Chang Chun-Shin, Hsiao Yen-Chang
Private Practice, Newport Beach, California.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Facial Plast Surg. 2016 Aug;32(4):452-9. doi: 10.1055/s-0036-1584555. Epub 2016 Aug 5.
Saddle nose deformity is challenging because there is both aesthetic and functional compromise, and high rates of recurrence have been reported. Autologous costal cartilage is the widely preferred medium for reconstruction, but there may be room for improvement in the configuration of the cartilage struts. The pi graft is stabilized at two points, proximally and distally, distinguishing it from the traditional L-strut. Indications include severe (Types III and IV) saddle nose deformity with collapse of the mid-vault, and recurrence after prior reconstruction. Costal cartilage is harvested and three struts are crafted to make the foundation layer: a dorsal strut, caudal strut, and mid-vault strut. An aesthetic layer is composed of a carefully crafted dorsal graft and tip graft. Three men and 11 women were treated from 2013 to 2015 using this method for severe saddle nose deformity. Aesthetic and functional outcomes were evaluated. Patients were followed up for 12 months (range, 8-14 months). There was no recurrence of deformity or warping of the aesthetic or foundation layers. All patients were guided to anticipate refinement of the tip at 3 months to ease the burden on the skin envelope in stage I, but only five patients (35.7%) opted for it, as the remaining patients were satisfied with their appearance. The pi graft is a composite reconstructive method that is designed to minimize warping and recurrence of the saddle nose deformity. This method was successful in this series, although objective comparisons with traditional methods were not made.
鞍鼻畸形的治疗具有挑战性，因为它既存在美学缺陷又有功能障碍，且据报道复发率较高。自体肋软骨是重建手术中广泛首选的材料，但软骨支柱的构型可能还有改进空间。π形移植片在近端和远端两点固定，这使其有别于传统的L形支柱。适应症包括伴有中鼻拱塌陷的重度（III型和IV型）鞍鼻畸形，以及既往重建术后的复发。采集肋软骨并制作三个支柱作为基础层：一个鼻背支柱、一个鼻尾支柱和一个中鼻拱支柱。美学层由精心制作的鼻背移植片和鼻尖移植片组成。2013年至2015年，采用这种方法治疗了3名男性和11名女性的重度鞍鼻畸形。评估了美学和功能效果。对患者进行了12个月（范围8 - 14个月）的随访。畸形没有复发，美学层或基础层也没有扭曲。所有患者在第I阶段均被指导在3个月时对鼻尖进行细化，以减轻皮肤包膜的负担，但只有5名患者（35.7%）选择这样做，因为其余患者对自己的外观很满意。π形移植片是一种复合重建方法，旨在最大限度地减少鞍鼻畸形的扭曲和复发。尽管未与传统方法进行客观比较，但该方法在本系列中取得了成功。
