Chien Lillian, Yver Christina M, Shohat Shirly, Friedman Oren
Division of Facial Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Facial Plast Surg Aesthet Med. 2024 Mar-Apr;26(2):117-123. doi: 10.1089/fpsam.2022.0162. Epub 2023 Sep 29.
There is no consensus on optimal repair technique for nasal septal perforations (NSPs). To measure success rate and evaluate predictors of success for NSP repair. Medical records of patients who underwent NSP repair from 2010 to 2020 were reviewed. Included patients had at least 60 days of postsurgical follow-up. Surgical technique involves an endonasal approach; subperichondrial dissection with local flap mobilization; and multilayer closure using cartilage interposition graft, fascia graft, and mucoperichondrial flaps. A chi-squared test or Fisher exact test was used for statistical analysis. Eighty-one repairs were performed with a closure rate of 86%. The median patient age was 46 years (range 13-77); 34.6% of perforations were ≥2 cm. Conchal (77.8%), rib (7.4%), or septal (7.4%) cartilage was used as graft material. A complication rate of 8.6% was reported. Perforation size or graft material had no impact on successful closure rate. Of patients with failed repairs, 55% had perioperative complications or conditions associated with poor healing. An endonasal approach for NSP repair showed a high success rate across diverse presentations; however, NSP repair was significantly more likely to be successful in patients without perioperative complications or pre-existing conditions associated with poor wound healing.
对于鼻中隔穿孔（NSP）的最佳修复技术尚无共识。为了衡量成功率并评估NSP修复的成功预测因素，我们回顾了2010年至2020年期间接受NSP修复的患者的病历。纳入的患者术后至少随访60天。手术技术包括鼻内入路；局部皮瓣动员的软骨膜下剥离；以及使用软骨植入移植物、筋膜移植物和粘软骨膜瓣进行多层闭合。采用卡方检验或Fisher精确检验进行统计分析。共进行了81次修复，闭合率为86%。患者的中位年龄为46岁（范围13 - 77岁）；34.6%的穿孔≥2厘米。使用耳甲软骨（77.8%）、肋软骨（7.4%）或鼻中隔软骨（7.4%）作为移植材料。报告的并发症发生率为8.6%。穿孔大小或移植材料对成功闭合率没有影响。在修复失败的患者中，55%有围手术期并发症或与愈合不良相关的情况。鼻内入路修复NSP在不同表现形式中均显示出较高的成功率；然而，在没有围手术期并发症或既往存在与伤口愈合不良相关情况的患者中，NSP修复成功的可能性显著更高。
