Kridel R W, Foda H, Lunde K C
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center, Houston, USA.
Arch Otolaryngol Head Neck Surg. 1998 Jan;124(1):73-8. doi: 10.1001/archotol.124.1.73.
Connective tissue autografts are commonly used as interpositional grafts between septal flaps in the repair of septal perforations. The most common graft materials used include temporalis fascia and pericranium, both of which are accompanied by donor site morbidity, do not provide septal bulk, and are exceedingly thin and difficult to manage.
To study the use of an acellular human dermal allograft (AlloDerm, LifeCell Corp, The Woodlands, Tex) as a connective tissue interpositional graft in septal perforation repair.
Private facial plastic surgery and reconstructive practice of 1 of the authors (R.W.H.K.), Houston, Tex, and the private and university practice of another author (H.F.), Alexandria, Egypt.
Twelve consecutive patients with septal perforation who received the acellular dermal allograft constituted this evaluation. The causes of the septal perforations were previous nasal surgery, previous nasal cautery, or cocaine use by the patient.
Interposition grafting between mucoperichondrial flaps for septal perforation repair was accomplished with decellularized human dermal grafts. Follow-up periods ranged from 3 to 14 months.
The repair was considered successful when, on postoperative examination at 3 months, the right and left mucoperichondrial flaps were entirely healed. From the experience of 1 author (R.W.H.K.) with the repair of more than 75 septal perforations, no perforation that was healed at 3 months broke down at a later date, unless trauma or cocaine use occurred after the operation. An outcome was considered acceptable but nondesirable if a perforation was still present after the operation but the number and severity of the patient's symptoms were reduced and the perforation was considerably smaller than before the operation.
Eleven of the 12 patients had successful outcomes with complete closure of their perforations. The 1 remaining patient had an acceptable result but incomplete closure; his initial perforation of 3 cm was reduced to 5 mm, making him asymptomatic after surgery.
Acellular human dermal grafts can be used as connective tissue interpositional grafts in the repair of septal perforations with success rates similar to the use of temporalis fascia, mastoid periosteum, or pericranium. One distinct advantage is the absence of donor-site morbidity. In addition, this graft material is thicker and easier to place and suture and may give more substance to the repaired septum.
在鼻中隔穿孔修复中，结缔组织自体移植物常被用作鼻中隔瓣之间的插入移植物。最常用的移植物材料包括颞肌筋膜和颅骨膜，这两种材料都会带来供区并发症，不能增加鼻中隔的体积，而且非常薄，难以操作。
研究脱细胞人真皮同种异体移植物（AlloDerm，LifeCell公司，得克萨斯州伍德兰兹）作为鼻中隔穿孔修复中结缔组织插入移植物的应用。
其中一位作者（R.W.H.K.）在得克萨斯州休斯顿的私人面部整形与重建诊所，以及另一位作者（H.F.）在埃及亚历山大的私人及大学诊所。
连续12例接受脱细胞真皮同种异体移植物的鼻中隔穿孔患者构成了本评估。鼻中隔穿孔的原因包括既往鼻部手术、既往鼻部烧灼或患者使用可卡因。
使用脱细胞人真皮移植物在粘软骨膜瓣之间进行插入移植以修复鼻中隔穿孔。随访期为3至14个月。
术后3个月检查时，若左右粘软骨膜瓣完全愈合，则修复被认为成功。根据一位作者（R.W.H.K.）修复75例以上鼻中隔穿孔的经验，3个月时愈合的穿孔在后期没有再裂开，除非术后发生创伤或使用可卡因。如果术后仍有穿孔，但患者症状的数量和严重程度减轻，且穿孔比手术前明显变小，则结果被认为可接受但不理想。
12例患者中有11例获得成功，穿孔完全闭合。剩下的1例患者结果可接受但穿孔未完全闭合；其最初3厘米的穿孔缩小至5毫米，术后无症状。
脱细胞人真皮移植物可作为结缔组织插入移植物用于鼻中隔穿孔修复，成功率与使用颞肌筋膜、乳突骨膜或颅骨膜相似。一个明显的优点是没有供区并发症。此外，这种移植物材料更厚，更容易放置和缝合，可能会使修复后的鼻中隔更充实。
