Zenga Joseph, Kao Katherine, Chen Collin, Gross Jennifer, Hahn Samuel, Chi John J, Branham Gregory H
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri.
Department of Otolaryngology, ENT Associates at GBMC, Baltimore, Maryland.
Facial Plast Surg. 2017 Feb;33(1):52-57. doi: 10.1055/s-0036-1593747. Epub 2017 Feb 22.
The objective of this study was to describe outcomes for patients who underwent titanium mesh reconstruction of full-thickness nasal defects without internal lining repair. This is a retrospective cohort study. Patients with through-and-through nasal defects were identified at a single academic institution between 2008 and 2016. Nasal reconstruction was performed with either titanium mesh and external skin reconstruction without repair of the intranasal lining or traditional three-layer closure. Five patients underwent titanium mesh reconstruction and 11 underwent traditional three-layer repair. Median follow-up was 11 months (range, 2-66 months). The only significant difference between groups was older age in patients undergoing titanium reconstruction (mean, 81 vs. 63 years; difference of 18; 95% confidence interval [CI], 4-32 years). Defect extent including overall size and structures removed was similar between groups ( > 0.05). Paramedian forehead flap was the most common external reconstruction in both groups (100% for titanium mesh and 73% for three-layer closure). Time under anesthesia was significantly shorter for titanium mesh reconstruction (median, 119 vs. 314 minutes; difference of 195; 95% CI, 45-237). Estimated blood loss and length of hospital stay were similar between groups ( > 0.05). Complication rates were substantial although not significantly different, 40 and 36% in titanium and three-layer reconstruction, respectively ( > 0.05). All patients with complications after titanium reconstruction had prior or postoperative radiotherapy. Titanium mesh reconstruction of through-and-through nasal defects can successfully be performed without reconstruction of the intranasal lining, significantly decreasing operative times. This reconstructive technique may not be suitable for patients who undergo radiotherapy.
本研究的目的是描述未进行内衬修复的全层鼻缺损患者接受钛网重建后的治疗结果。这是一项回顾性队列研究。2008年至2016年期间，在一家学术机构中识别出患有贯通性鼻缺损的患者。鼻重建采用钛网和外部皮肤重建而不修复鼻内衬，或采用传统的三层闭合术。5例患者接受了钛网重建，11例接受了传统的三层修复。中位随访时间为11个月（范围2 - 66个月）。两组之间唯一的显著差异是接受钛重建的患者年龄较大（平均年龄分别为81岁和63岁；相差18岁；95%置信区间[CI]，4 - 32岁）。两组之间包括总体大小和切除结构在内的缺损范围相似（>0.05）。旁正中前额皮瓣是两组中最常见的外部重建方式（钛网组为100%，三层闭合组为73%）。钛网重建的麻醉时间明显更短（中位时间分别为119分钟和314分钟；相差195分钟；95%CI，45 - 237）。两组之间的估计失血量和住院时间相似（>0.05）。并发症发生率较高，尽管无显著差异，钛网重建组和三层重建组分别为40%和36%（>0.05）。所有钛重建后出现并发症的患者均接受过术前或术后放疗。贯通性鼻缺损的钛网重建可以在不重建鼻内衬的情况下成功进行，显著缩短手术时间。这种重建技术可能不适用于接受放疗的患者。
