Khoo Lee Seng, Yen Cheng-I, Chang Chun-Shin, Chen Hung-Chang, Huang Chih-Jung, Hsiao Yen-Chang
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
Aesthet Surg J. 2019 Oct 15;39(11):1182-1190. doi: 10.1093/asj/sjz121.
Silicone-polytetrafluoroethylene composite implants are fast gaining popularity in Asian rhinoplasty. Nonetheless, implant displacement, erythematous reactions, and infections still occur in the authors' patient group during long-term follow-up.
The authors reported successful experience of combining the utilization of silicone-polytetrafluoroethylene composite implants with onlay temporal fascial grafts to circumvent these complications.
Sixty-four patients of Asian ethnicity underwent augmentation rhinoplasty utilizing an I-shaped composite implant with an onlay fascial graft from January 2015 to June 2018, with a mean follow-up period of 13.5 months. This patient group was compared with a control group of 177 Asian patients who underwent augmentation rhinoplasty utilizing the same composite implant but without the addition of a fascial graft; the control group was treated from February 2012 to June 2015, with a mean follow-up of 42.0 months. Complications were compared between these 2 patient groups, specifically focusing on malposition/deviations, erythema, and infections.
There was a marked decrease in complication rates with the addition of an onlay temporal fascial graft to cover the composite implant in augmentation rhinoplasty (7.8% vs 14.7%) as well as the rate of erythematous reactions (0% vs 6.2%, P = 0.04), infection (1.6% vs 1.1%), and implant malposition/deviation (0% vs 4.5%). Harvesting the temporal fascia and fashioning the onlay graft added an additional 33 minutes on average per procedure. No donor site morbidity was encountered.
Although the operative time increased, the benefits of adding onlay fascial grafts to silicone-polytetrafluoroethylene implants in alloplastic augmentation rhinoplasty outweigh the drawbacks, as evidenced by the decrease in erythematous reactions.
硅胶-聚四氟乙烯复合植入物在亚洲鼻整形术中迅速受到欢迎。尽管如此，在作者的患者群体中，长期随访期间仍会出现植入物移位、红斑反应和感染。
作者报告了将硅胶-聚四氟乙烯复合植入物与颞部筋膜覆盖移植相结合以规避这些并发症的成功经验。
2015年1月至2018年6月，64名亚洲患者接受了使用I形复合植入物并联合颞部筋膜覆盖移植的隆鼻术，平均随访期为１3.5个月。该患者组与177名接受相同复合植入物但未加筋膜覆盖移植的亚洲隆鼻患者对照组进行比较；对照组于2012年2月至2015年6月接受治疗，平均随访42.0个月。比较这两组患者的并发症，特别关注位置异常/偏斜、红斑和感染。
在隆鼻术中添加颞部筋膜覆盖复合植入物后，并发症发生率显著降低（7.8%对14.7%），红斑反应发生率（0%对6.2%，P = 0.04）、感染率（1.6%对1.1%）和植入物位置异常/偏斜率（0%对4.5%）也显著降低。采集颞部筋膜并制作覆盖移植片平均每例手术额外增加33分钟。未出现供区并发症。
虽然手术时间增加，但在异体材料隆鼻术中，硅胶-聚四氟乙烯植入物添加颞部筋膜覆盖移植的益处超过弊端，红斑反应减少即证明了这一点。
