From Dr. Kook's Plastic Surgery Clinic.
the Department of Plastic and Reconstructive Surgery, Institute of Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine.
Plast Reconstr Surg. 2023 Jul 1;152(1):45-54. doi: 10.1097/PRS.0000000000010205. Epub 2023 Jun 29.
Silicone implant augmentation rhinoplasty along with various tip plasties are commonly performed in Asian patients, but a revision rhinoplasty is frequently required because of various problems. Secondary rhinoplasties are often performed using silicone, dermofat, costal cartilage block, or diced rib cartilage, but often result in unsatisfactory outcomes. This study assessed the surgical outcomes and complications of cross-linked acellular dermal matrix (ADM) as an alternative biological substitute for silicone implant in secondary rhinoplasty.
The authors prospectively studied 56 patients with a minimum follow-up of 1 year among 104 patients who underwent secondary rhinoplasty in their clinic between January of 2015 and December of 2018. Silicone implant, capsule, and scar tissue removal; dorsal augmentation with ADM; and tip plasty using autogenous cartilage were performed for all of them. The results were assessed using the modified Rhinoplasty Outcome Evaluation, consisting of a 10-item questionnaire completed preoperatively, 6 months postoperatively, and over 1 year postoperatively.
One infection and three cases of excessive resorption were noted, with no other major complications. The mean modified Rhinoplasty Outcome Evaluation score was 31.7 on preoperative evaluation, 77.3 at 6 months postoperatively, and 81.4 at 1 year postoperatively (mean difference, 45.6 and 49.7, respectively; P < 0.001).
Various problems that occur after primary rhinoplasty using silicone implants can be resolved successfully with secondary rhinoplasty by dorsal augmentation using the cross-linked human ADM along with various nasal tip work using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, a low infection rate, firm fixation of the implant, good skin texture/thickness of the skin/soft-tissue envelope, and gain of desired height and dorsal line.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
硅胶假体隆鼻术联合各种鼻尖整形术常用于亚洲患者，但由于各种问题，常需进行修复性隆鼻术。二次鼻整形术常使用硅胶、真皮脂肪、肋软骨块或肋软骨碎块，但常导致不满意的结果。本研究评估了交联脱细胞真皮基质（ADM）作为硅胶假体在二次鼻整形术替代物的手术效果和并发症。
作者前瞻性研究了 2015 年 1 月至 2018 年 12 月在其诊所接受二次鼻整形术的 104 例患者中的 56 例患者，这些患者的随访时间至少为 1 年。所有患者均接受硅胶假体、包膜和瘢痕组织切除；ADM 背侧填充；以及自体软骨鼻尖整形术。使用改良鼻整形术后评估量表，对所有患者进行术前、术后 6 个月和 1 年以上的评估，评估结果包括 10 项问卷。
1 例感染和 3 例过度吸收，无其他重大并发症。术前改良鼻整形术后评估平均得分为 31.7 分，术后 6 个月为 77.3 分，术后 1 年为 81.4 分（平均差异分别为 45.6 和 49.7，P < 0.001）。
使用硅胶假体进行初次鼻整形术后出现的各种问题，可以通过背侧 ADM 填充联合自体软骨进行各种鼻尖整形术的二次鼻整形术成功解决。手术结果显示挛缩畸形得到了很好的解决，感染率低，假体固定牢固，皮肤质地/厚度/软组织包膜良好，获得了所需的高度和背线。
临床问题/证据水平：治疗性，IV 级。
