From the Dallas Plastic Surgery Institute and Ganga Hospital.
Plast Reconstr Surg. 2019 Sep;144(3):614-622. doi: 10.1097/PRS.0000000000005996.
Correction of secondary nasal deformities frequently requires cartilage to build the framework of the nose. Traditionally, autologous costal cartilage has been used because of the paucity of the septal cartilage. Because of associated donor-site complications and increased operating time, irradiated allografts have been used. These grafts have a higher rate of resorption and infection. Thus, the authors have used fresh frozen, nonirradiated, cadaveric rib cartilage as donor cartilage to avoid these shortcomings, and they present their early experience.
The operative data of 50 patients who underwent secondary rhinoplasty performed by the senior author between 2014 and 2017 were analyzed. The outcomes of the rhinoplasty were evaluated by preoperative and postoperative photographs by four blinded plastic surgeons, and the results were tabulated using the Independent Rhinoplasty Outcome Score.
Fifty patients were followed up over an average period of 3.35 months (range, 1 to 18 months). There was only one complication (infection, 2 percent), which did not need revision surgery. There was no warping or extrusion in this cohort.
The authors believe that fresh frozen, nonirradiated cartilage allografts are an evolving source of donor cartilage grafts for revision rhinoplasty because they are associated with lower complication rates. However, further long-term studies with an increased sample size are necessary to prove that fresh frozen cartilage grafts are better than other sources.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
矫正继发鼻部畸形常需要软骨来构建鼻部框架。由于鼻中隔软骨的缺乏,传统上一直使用自体肋软骨。由于相关供区并发症和手术时间延长,已使用辐照同种异体移植物。这些移植物吸收和感染的发生率更高。因此,作者使用新鲜冷冻、未辐照、尸体肋骨软骨作为供体软骨来避免这些缺点,并介绍他们的早期经验。
分析了 2014 年至 2017 年间由资深作者进行的 50 例继发鼻整形术患者的手术数据。由四位盲法整形医生通过术前和术后照片评估鼻整形术的结果,并使用独立鼻整形术结果评分表进行列表。
50 例患者平均随访 3.35 个月(范围 1 至 18 个月)。仅发生 1 例并发症(感染,2%),无需再次手术。该队列中未发生扭曲或挤出。
作者认为,新鲜冷冻、未辐照的软骨同种异体移植物是修复性鼻整形术供体软骨移植物的一种不断发展的来源,因为它们与较低的并发症发生率相关。然而,需要进一步进行长期研究并增加样本量,以证明新鲜冷冻软骨移植物比其他来源更好。
临床问题/证据水平:治疗,IV。