St Denis-Katz Hannah N, Bastianelli Michael, Macdonald Jillian, Zhang Jing
Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Department of Surgery, Division of Plastic Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Plast Reconstr Surg Glob Open. 2022 Jul 29;10(7):e4431. doi: 10.1097/GOX.0000000000004431. eCollection 2022 Jul.
The use of local anesthesia in nasal surgery has gained popularity as a cost-effective and safe alternative. With the potential benefit of reconstruction without using general anesthesia, the goal of the study was to evaluate the patient-reported experience in addition to surgical outcomes and perioperative complications.
A mixed-methods study was completed with retrospective chart review and patient-reported outcome questionnaire. The primary outcome measures were demographics, oncologic and surgical details, and postoperative complications. Secondary outcome measures were aesthetic outcomes and procedure tolerance, which were gathered from the FACE-Q questionnaire.
Of the 22 patients who met inclusion criteria, nine patients (41%) had forehead flaps performed and 13 patients (59%) had multilayer reconstruction with local flaps and cartilage grafts. The average number of surgeries performed, including revisions, was 2.3 ± 0.2. The overall complication rate for reconstructions and revisions was 20%, most of these were minor complications. The overall subjective rating of patient's appearance was excellent with an average score of 83.9 (± 17.3) out of 100. There was minimal appearance distress as a product of the surgery with an average score of 84.9 (±18.8). On a scale of one to five, patients reported an average of 4.3 for convenience, 3.8 for efficiency of setup and procedure, and 3.4 out of 5 for comfortability with having an operation performed on their face wide awake.
Our study demonstrated that complex nasal reconstruction performed under local anesthetic in a minor procedure setting is a feasible and safe option with good patient-reported outcomes.
局部麻醉在鼻科手术中的应用作为一种经济高效且安全的替代方法已越来越受欢迎。鉴于无需全身麻醉即可进行重建的潜在益处，本研究的目的是除了评估手术结果和围手术期并发症外，还评估患者报告的体验。
通过回顾性病历审查和患者报告结局问卷完成了一项混合方法研究。主要结局指标包括人口统计学、肿瘤学和手术细节以及术后并发症。次要结局指标是美学效果和手术耐受性，这些是从FACE-Q问卷中收集的。
在符合纳入标准的22例患者中，9例（41%）进行了额部皮瓣手术，13例（59%）采用局部皮瓣和软骨移植进行了多层重建。包括翻修手术在内，平均手术次数为2.3±0.2次。重建和翻修手术的总体并发症发生率为20%，其中大多数为轻微并发症。患者外观的总体主观评分为优秀，平均得分为83.9（±17.3）（满分100分）。手术导致的外观困扰极小，平均得分为84.9（±18.8）。在1至5分的评分中，患者报告便利性平均为4.3分，设置和手术效率为3.8分，在完全清醒状态下脸部接受手术的舒适度为3.4分（满分5分）。
我们的研究表明，在小型手术环境中采用局部麻醉进行复杂鼻重建是一种可行且安全的选择，患者报告的结局良好。
