Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Facial Plast Surg Aesthet Med. 2024 Jul-Aug;26(4):456-462. doi: 10.1089/fpsam.2023.0240. Epub 2024 Feb 13.
Nasal skin necrosis represents a severe rhinoplasty complication, potentially leading to nasal deformity and psychological distress. To assess the safety, nasal function enhancement, and esthetic satisfaction in individuals with a history of nasal skin necrosis following reconstructive septorhinoplasty using patient-reported outcome measures. The case series included patients who underwent reconstructive septorhinoplasty 1 year after experiencing skin necrosis. Skeletal reconstruction was performed with an open approach using various autografts and techniques. The data collected encompassed demographics, medical history, operative reports, and postoperative events. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively. Most patients were female (35/38, 92%), with median age of 33.5 years (17-57) and 2 prior rhinoplasties (1-5) by 1 surgeon (1-2). The follow-up median was 23.78 months (11.83-54.23). Necrosis predominantly affected the nasal tip and soft tissue triangles. Septorhinoplasty utilized 11 V-shaped columellar base and 27 mid-columella incisions, lasting on average 274 min (175-405). Septal grafts were adequate for reconstruction in only three cases. Autografts for reconstruction encompassed auricular cartilage (31), rib cartilage (22), temporal fascia (14), and rectus fascia (6). SCHNOS scores improved significantly, with the obstruction domain decreasing from a preoperative mean of 75.92 (±22.83) to 34.08 (±27.87) and the cosmesis domain from 85.43 (±19.06) to 39.73 (±23.77). No postoperative severe vascular complication occurred. More previous surgeries linked to decreased patient satisfaction. Reconstructive septorhinoplasty can be successful in restoring relatively normal nasal contour following prior soft tissue necrosis, with limited risk for complications.
鼻皮肤坏死是一种严重的鼻整形并发症，可能导致鼻畸形和心理困扰。本研究旨在使用患者报告的结果测量评估既往有鼻皮肤坏死病史的患者在接受重建鼻中隔成形术后的安全性、鼻功能改善和美学满意度。该病例系列纳入了 1 年前经历过皮肤坏死的患者，这些患者接受了重建鼻中隔成形术。采用开放式方法进行骨骼重建，使用各种自体移植物和技术。收集的数据包括人口统计学资料、病史、手术报告和术后事件。术前和术后 1 年使用标准化美容和健康鼻结局调查（SCHNOS）进行评估。大多数患者为女性（35/38，92%），中位年龄 33.5 岁（17-57 岁），由同一位医生进行了 2 次（1-2 次）之前的鼻整形术。中位随访时间为 23.78 个月（11.83-54.23）。坏死主要影响鼻尖和软组织三角。鼻中隔成形术采用 11 个 V 形鼻中隔基底和 27 个鼻中隔中段切口，平均持续时间为 274 分钟（175-405 分钟）。只有 3 例鼻中隔移植物足以进行重建。用于重建的自体移植物包括耳软骨（31 例）、肋软骨（22 例）、颞筋膜（14 例）和腹直肌筋膜（6 例）。SCHNOS 评分显著改善，阻塞域从术前的平均 75.92（±22.83）降至 34.08（±27.87），美容域从 85.43（±19.06）降至 39.73（±23.77）。术后无严重血管并发症发生。更多的既往手术与患者满意度降低有关。对于既往软组织坏死患者，重建鼻中隔成形术可成功恢复相对正常的鼻轮廓，并发症风险有限。
