From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
Plast Reconstr Surg. 2021 Jan 1;147(1):76e-81e. doi: 10.1097/PRS.0000000000007431.
Autologous cartilage grafts have a low risk of infection and extrusion in cleft rhinoplasty. However, harvesting autologous cartilage involves donor-site morbidity and increased time under anesthesia. Irradiated homologous costal cartilage grafts may be an effective alternative.
A retrospective study was performed on patients with a history of cleft lip who underwent rhinoplasty for cleft nasal deformity at Johns Hopkins Hospital from 2009 to 2018. Patients were excluded if their rhinoplasty did not involve a cartilage graft.
One hundred sixty-five cleft rhinoplasties (patient age, 2 to 72 years; 52 percent female) were performed. Median follow-up time was 256 days; 30 percent were revision operations. Ninety-six procedures (58 percent) used irradiated homologous costal cartilage grafts, with the remaining using autologous cartilage. Complications resulted from 18 procedures (11 percent), seven (10 percent) involving autologous cartilage and 11 (12 percent) involving irradiated homologous costal cartilage. Most autologous cartilage complications (86 percent) required operative intervention, versus seven of 11 (64 percent) for irradiated homologous costal cartilage. Complications associated with irradiated homologous costal cartilage included infection (n = 5), warping (n = 2), and extrusion (n = 1), while two patients with autologous cartilage experienced collapse and one each experienced resorption, warping, and hypertrophic donor-site scarring. There was no difference between groups regarding complication rate or complications requiring operative intervention (p = 0.3 and p = 0.5, respectively).
Irradiated homologous costal cartilage grafts are equally safe and effective as autologous cartilage for use in cleft rhinoplasty. These grafts are readily available and eliminate donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
自体软骨移植物在唇裂鼻整形术中感染和挤出的风险较低。然而，采集自体软骨会涉及供体部位的发病率增加，并且需要在麻醉下的时间延长。辐照同源肋软骨移植物可能是一种有效的替代方法。
对 2009 年至 2018 年期间在约翰霍普金斯医院接受唇裂鼻畸形修复术的唇裂患者进行了一项回顾性研究。如果患者的鼻整形术不涉及软骨移植物，则将其排除在外。
共进行了 165 例唇裂鼻整形术（患者年龄 2 至 72 岁；女性占 52%）。中位随访时间为 256 天；30%为修复手术。96 例（58%）手术使用辐照同源肋软骨移植物，其余使用自体软骨。18 例（11%）出现并发症，7 例（10%）涉及自体软骨，11 例（12%）涉及辐照同源肋软骨。大多数自体软骨并发症（86%）需要手术干预，而辐照同源肋软骨的 11 例并发症中，有 7 例（64%）需要手术干预。与辐照同源肋软骨相关的并发症包括感染（n=5）、变形（n=2）和挤出（n=1），而 2 例自体软骨患者出现塌陷，1 例患者分别出现吸收、变形和增生性供体部位瘢痕。两组在并发症发生率或需要手术干预的并发症方面没有差异（p=0.3 和 p=0.5）。
辐照同源肋软骨移植物在唇裂鼻整形术中与自体软骨同样安全有效。这些移植物易于获得，并可消除供体部位的发病率。
临床问题/证据水平：治疗性，III 级。
