Sazgar Amir A, Sazgar Mehr A, Zarei Rojan, Sazgar Amir K
Aesthet Surg J. 2025 Jul 15;45(8):770-779. doi: 10.1093/asj/sjaf060.
Columellar incision techniques for multiply operated and/or severely compromised noses are critical in reconstructive rhinoplasty, because they impact both the final outcome and the risk of complications, such as wound dehiscence and skin flap necrosis.
The aims of the study are to evaluate the safety of the columella-labial incision in patients with previous mid-columellar scars and assess the functional and aesthetic outcomes of reconstructive septorhinoplasty using this strategic incision through patient-reported outcome measures and chart reviews.
This case series included patients with previous unsuccessful rhinoplasties and mid-columellar scars who underwent open-approach reconstructive septorhinoplasty with a columella-labial incision. Collected data included demographics, medical history, operative reports, and postoperative events. Skeletal reconstruction was performed using various autografts. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively.
Most patients were female (68/91, 75%), with a mean age of 37.6 years and 1.74 previous rhinoplasties. The average surgery duration was 239.5 min. Autografts included auricular cartilage (64), costal cartilage (43), temporal fascia (12), and rectus fascia (24). No cases of dehiscence or vascular complications occurred, even in patients with multiple previous mid-columellar incisions. SCHNOS scores significantly improved, with obstruction scores decreasing from 52.86 to 18.43 (standard deviation [SD] = 8.33 vs 3.95) and cosmesis scores from 78.09 to 20.19 (SD = 6.44 vs 5.13).
The V-shaped columella-labial incision does not increase the risk of vascular compromise, even in patients with mid-columellar scars. Its strategic use facilitates skeletal reconstruction while effectively improving nasal contour and columellar length with acceptable scarring.
对于多次手术和/或严重受损的鼻子，鼻小柱切口技术在鼻整形修复术中至关重要，因为它会影响最终效果以及诸如伤口裂开和皮瓣坏死等并发症的风险。
本研究的目的是通过患者报告的结局指标和图表回顾，评估鼻小柱唇切口在有鼻小柱中部既往瘢痕患者中的安全性，并评估使用该策略性切口进行鼻中隔鼻整形修复术的功能和美学效果。
本病例系列包括有既往鼻整形手术失败和鼻小柱中部瘢痕的患者，他们接受了采用鼻小柱唇切口的开放式鼻中隔鼻整形修复术。收集的数据包括人口统计学、病史、手术报告和术后事件。使用各种自体移植物进行骨骼重建。术前和术后1年进行标准化美容和健康鼻腔结局调查（SCHNOS）。
大多数患者为女性（68/91，75%），平均年龄37.6岁，既往平均有1.74次鼻整形手术。平均手术时间为239.5分钟。自体移植物包括耳软骨（64例）、肋软骨（43例）、颞筋膜（12例）和腹直肌筋膜（24例）。即使是有多次鼻小柱中部既往切口的患者，也未发生裂开或血管并发症病例。SCHNOS评分显著改善，阻塞评分从52.86降至18.43（标准差[SD]=8.33对3.95），美容评分从78.09降至20.19（SD=6.44对5.13）。
即使在有鼻小柱中部瘢痕的患者中，V形鼻小柱唇切口也不会增加血管受损的风险。其策略性应用有助于骨骼重建，同时有效改善鼻外形和鼻小柱长度，且瘢痕可接受。
