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Singh D, Zhang R, Hori KH, Parsa FD. Is Iatrogenic Implant Contamination Preventable Using a 16-Step No-Touch Protocol? EPLASTY 2022; 22:e38. [PMID: 36160667 PMCID: PMC9490878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intraoperative contamination of the surgical field during aesthetic breast augmentation may lead to implant infection with devastating consequences. This study covers a period of 30 years and is divided into 2 phases: a retrospective phase from 1992-2004 when a standard approach was used and a prospective phase from 2004-2022 when a no-touch approach was implemented to avoid contamination. METHODS Patients in the standard and no-touch groups underwent aesthetic breast augmentation by the same senior surgeon (FDP) in the same outpatient surgical facility during the 30-year period of the study. Patients are divided into 2 groups: from 1992-2004 and from the implementation of the no-touch protocol in 2004-2022. RESULTS Patients who underwent breast augmentation using the no-touch approach developed no infections, whereas the standard group had an infection rate of 3.54% (P = .017). The validity of this finding is discussed. CONCLUSIONS The no-touch approach as described in this article was effective in reducing implant infection rate when performing aesthetic breast augmentation by 1 surgeon at 1 surgical center during an 18-year observation period. Multicenter prospective cooperative studies are necessary to validate perioperative iatrogenic contamination as the cause of implant infection and to explore optimal approaches that could eliminate implant contamination.
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Affiliation(s)
- Dylan Singh
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | - Ruixue Zhang
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | | | - Fereydoun D Parsa
- Plastic Surgery Division, Department of Surgery, University of Hawaii, John A Burns School of Medicine. Honolulu, HI
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2
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Kao WK, Faddis B, Chole RA, Davis RE. Evidence of Biofilm and Persister Cell Formation in Revision Rhinoplasty. Facial Plast Surg Aesthet Med 2022; 24:233-238. [DOI: 10.1089/fpsam.2021.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W. Katherine Kao
- Department of Otolaryngology, University of Texas Health Science Center in Houston, McGovern Medical School, Houston, Texas, USA
| | - Brian Faddis
- Department of Otolaryngology, Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Richard A. Chole
- Department of Otolaryngology, Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
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3
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Toriumi DM, Kowalczyk DM, Cristel RT, Caniglia AJ, Curran N, Lombard R, Kerolus JL. Evaluation of Postoperative Infection Rates in 3084 Rhinoplasty Cases Using Antibiotic Soaks and/or Irrigations. Facial Plast Surg Aesthet Med 2021; 23:368-374. [PMID: 33798400 DOI: 10.1089/fpsam.2020.0465] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Postoperative infections after rhinoplasties are rare, yet devastating on patient outcomes. The literature reports an overall incidence of <2% with higher numbers seen in those requiring revision procedures. Materials and Methods: A retrospective chart review of rhinoplasty patients from 2002 to 2019 of the primary author (D.M.T.) was performed. The objective of this study is to demonstrate the use of postoperative antibiotic soaks and irrigations in rhinoplasty, as well as evaluate the postoperative infection rates. Results: Of the 3084 rhinoplasty procedures evaluated, there were 19 postoperative infections (infection rate [IR] = 0.62%). Patients without antibiotic soaks or irrigations had 17 infections (IR = 1.01%). The IR of antibiotic soaks was 0.08% with a significant reduction compared with no soaks/irrigations (p = 0.0053). With antibiotic soaks and irrigations, there was 1 infection (IR = 0.49%) with no significant difference between no soaks/irrigations or soaks alone. Conclusions: The use of antibiotic soaks and irrigations resulted in an IR of 0.62%. Antibiotic soaks reduced the rate of postoperative infection, particularly in secondary rhinoplasty. Antibiotic soaks and irrigations are safe, effective, and well-tolerated by patients. As a result, these techniques may be considered in patients undergoing rhinoplasty, particularly those with an extensive revision history, trauma, filler, prior infection, or underlying disease processes.
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Affiliation(s)
- Dean M Toriumi
- Department of Otolaryngology-Head & Neck Surgery, Rush University Medical School, Chicago, Illinois, USA
| | - David M Kowalczyk
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert T Cristel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alexander J Caniglia
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nicholas Curran
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Rachel Lombard
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Julia L Kerolus
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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4
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Goodman GJ, Al‐Niaimi F, McDonald C, Ciconte A, Porter C. Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers. J Cosmet Dermatol 2020; 19:1846-1850. [DOI: 10.1111/jocd.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Greg J. Goodman
- Monash University Carlton Vic. Australia
- Skin Health Institute Carlton Vic. Australia
- University College of London London UK
| | - Firas Al‐Niaimi
- Guy’s Hospital London London UK
- 152 Harley Street Clinic London UK
- Department of Dermatology Aalborg University Hospital Aalborg Denmark
| | - Cara McDonald
- St Vincent’s Hospital Fitzroy Fitzroy Vic. Australia
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5
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Na HG, Jang YJ. Use of Nasal Implants and Dorsal Modification When Treating the East Asian Nose. Otolaryngol Clin North Am 2020; 53:255-266. [PMID: 32007303 DOI: 10.1016/j.otc.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dorsal augmentation and tip surgery are essential procedures for East Asians seeking rhinoplasty, because they generally have thicker skin and poorly developed nasal dorsum and tip. For dorsal augmentation, many Asian surgeons prefer using alloplastic material, like silicone, Gore-Tex, and filler injection, for cost-effectiveness, easy handling, and short operation times. Compared with autologous implant materials, the use of synthetic implant is suggested to be associated with many complications, such as infection, extrusion, and deviation. However, even with the use of the autologous material, problems such as reabsorption after grafting, donor site complications can take place.
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Affiliation(s)
- Hyung Gyun Na
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Yeungnam Cllege of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 05505, South Korea.
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6
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Moon KC, Jung JE, Dhong ES, Jeong SH, Han SK. Septorhinoplasty for Destructed Septal L-Strut in Patients with Previously Applied Porous High-Density Polyethylene Implants (Medpor ®). Aesthetic Plast Surg 2019; 43:1286-1294. [PMID: 31049638 DOI: 10.1007/s00266-019-01386-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Porous high-density polyethylene implants (Medpor®) have been extensively used for septal extension grafts in Asian rhinoplasty. However, studies on the long-term complications associated with Medpor® have not been reported. Therefore, the purpose of this study was to evaluate the long-term complications of septal extension grafts using Medpor® and present a reconstructive strategy for destructed septal L-struts. METHODS We conducted a 12-year retrospective medical chart review of 428 patients who visited our center for septorhinoplasty. Among 428 patients, 43 patients had Medpor® for septal extension grafts previously applied at other clinics. The quadrangular cartilage was devoid or destructed in the area where Medpor® was previously applied. Therefore, all patients underwent secondary septorhinoplasty using autogenous cartilage grafts. Patient outcome was assessed to evaluate satisfaction, hardness of nasal tip, functional nasal obstruction symptom evaluation (NOSE) scores, and pain scores. Anthropometric analyses were carried out with patients' photographs. Postoperative complications were also evaluated. RESULTS After septal L-strut reconstruction, 87% of patients were satisfied with their aesthetic results. Hardness of nasal tip, NOSE scores, and pain scores also improved after reconstruction. Anthropometric analyses demonstrated that increased nasal length and decreased columellar-labial angle were achieved in patients with short nose deformities. No postoperative complications related to the reconstruction were recorded for any patient. CONCLUSIONS The devastated destruction of nasal support lines was found after the use of Medpor® for septorhinoplasty. Therefore, the use of Medpor® should be reduced. Autogenous cartilage grafts are the last resort for reconstruction of destructed septal L-struts. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University Guro Hospital, 148 Gurodong-Gil, Guro-Ku, Seoul, 08308, South Korea
| | - Jae-Eun Jung
- Department of Plastic Surgery, Korea University Guro Hospital, 148 Gurodong-Gil, Guro-Ku, Seoul, 08308, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, 148 Gurodong-Gil, Guro-Ku, Seoul, 08308, South Korea.
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, 148 Gurodong-Gil, Guro-Ku, Seoul, 08308, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, 148 Gurodong-Gil, Guro-Ku, Seoul, 08308, South Korea
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7
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Pazarci O, Tutar U, Kilinc S. Investigation of the Antibiofilm Effects of Mentha longifolia Essential Oil on Titanium and Stainless Steel Orthopedic Implant Surfaces. Eurasian J Med 2019; 51:128-132. [PMID: 31258351 DOI: 10.5152/eurasianjmed.2019.18432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to determine the antibiofilm activity of Mentha longifolia essential oil (EO) against biofilms forming on in-vitro implant surfaces. Materials and Methods Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans biofilms were used. Stainless steel and titanium samples were grouped as control, water diluted, no EO addition, and reducing amounts of EO doses. The six microorganisms included in the study were investigated to examine if there were differences between the doses on the implant surfaces. The eradication effect of the EO in samples investigated with electron microscope was classified as 0: none, 1: mild, 2: moderate, and 3: severe. The chemical composition of the EO was determined with gas chromatography. Results In terms of biofilm formation, no difference was observed between implant surfaces. While S. aureus and C. albicans were observed to be the most susceptible, P. aeruginosa was identified as the most resistant. According to gas chromatography, M. longifolia EO comprised 61.40% carvacrol and 0.28% thymol. Conclusion In vitro, M. longifolia EO was shown to be effective against gram negative/positive and fungal biofilms forming on the surface of stainless steel and titanium implants.
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Affiliation(s)
- Ozhan Pazarci
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ugur Tutar
- Department of Nutrition and Dietetics, Cumhuriyet University of Health Sciences, Sivas, Turkey
| | - Seyran Kilinc
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
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8
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Toriumi DM. Choosing Autologous vs Irradiated Homograft Rib Costal Cartilage for Grafting in Rhinoplasty. JAMA FACIAL PLAST SU 2019; 19:188-189. [PMID: 28334413 DOI: 10.1001/jamafacial.2017.0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dean M Toriumi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago
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9
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Analysis of subclinical infections and biofilm formation in cases of capsular contracture after silicone augmentation rhinoplasty: Prevalence and microbiological study. Arch Plast Surg 2019; 46:160-166. [PMID: 30934181 PMCID: PMC6446030 DOI: 10.5999/aps.2018.00864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
Background Implant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty. Methods Thirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy. Results Thirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%). Conclusions As with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.
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10
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Delaney S, Kridel RWH. Enhancing Facelift With Simultaneous Submalar Implant Augmentation. Aesthet Surg J 2019; 39:351-362. [PMID: 29846508 DOI: 10.1093/asj/sjy135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The midface is particularly prone to the senescent changes of soft tissue ptosis and volume loss, which in individuals with aging or low adiposity can manifest as submalar hollowing. Facelift alone in those with submalar hollowing inadequately addresses the volume loss and may result in a gaunt appearance postoperatively. Submalar implant augmentation is a powerful tool for permanent midface volume restoration for a more youthful and natural contour, as opposed to soft tissue fillers that diminish over time. When performed together, submalar augmentation and facelift synergistically enhance facial rejuvenation results. OBJECTIVES Determine the long-term safety and efficacy of submalar implant augmentation as an adjunct to facelift. METHODS Retrospective review evaluating results and complications in all consecutive patients who had submalar implant augmentation with SMAS-plication facelift in a single surgeon private practice setting from January 1, 1991, to December 31, 2017. RESULTS Forty-eight patients underwent submalar augmentation with simultaneous facelift with an overall satisfaction rate of 95.7%. Complications included 2.1%transient infraorbital hypoesthesia, 1.1% prolonged swelling, and 1.1% capsular contraction that required a minor adjustment under local anesthesia. No infection, implant migration, or extrusion or facial nerve injury occurred. CONCLUSIONS Submalar implant augmentation is a safe and effective means of enhancing facelift results through midface volume restoration, subperiosteal release, and improved soft tissue suspension in a more favorable vector. Submalar implant augmentation performed simultaneously with facelift may be an attractive alternative to repeated soft tissue filler or fat injections for patients with submalar hollowing who are interested in facial rejuvenation surgery.
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Affiliation(s)
- Sean Delaney
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Russell W H Kridel
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX
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11
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Farrell NF, Kingdom TT, Getz AE, Lillehei KO, Youssef AS, Ramakrishnan VR. Development of Chronic Sphenoid Sinusitis After Sellar Reconstruction with Medpor Porous Polyethylene Implant. World Neurosurg 2018; 123:e781-e786. [PMID: 30579017 DOI: 10.1016/j.wneu.2018.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Medpor porous polyethylene implant is reported to be safe and effective for sellar reconstruction after transsphenoidal surgery (TSS). However, we have observed several cases of delayed chronic sphenoid sinusitis related to the implant. The purpose of this study is to describe the presentation and management of implant-related sphenoid sinusitis after sellar reconstruction. METHODS This is a retrospective study of patients who underwent endonasal TSS with Medpor sellar reconstruction between December 2008 and January 2013 at a tertiary care institution. Patient demographics, initial surgical management, sinonasal symptoms, postoperative imaging, sinusitis management, and resulting outcomes were analyzed. RESULTS From 2008-2013, 139 patients underwent sellar reconstruction using Medpor. Five patients (3.6%) presented between 8 and 60 months after surgery with chronic sphenoid sinusitis that required surgical management. All 5 patients presented as outpatients for management of headaches and nasal drainage, 4 patients experienced chronic nasal congestion, and 3 patients noted recurrent sinusitis. At the time of revision surgery, all 5 patients were found to have mucosal inflammation and edema surrounding the implant, and 4 of the 5 had an exposed or partially extruded implant that was removed. CONCLUSIONS Reconstruction of the sellar floor may be performed after TSS to prevent postoperative complications. Although porous polyethylene implants have previously been described as safe and effective for this purpose, surgeons should be aware of the risk of subsequent implant extrusion and chronic sphenoid sinusitis that can occur in a delayed manner.
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Affiliation(s)
- Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - A Samy Youssef
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
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12
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Abstract
A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.
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Affiliation(s)
- Na-Hyun Hwang
- Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-Gu, Seoul 152-703, Republic of Korea
| | - Eun-Sang Dhong
- Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-Gu, Seoul 152-703, Republic of Korea.
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13
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Abstract
Augmentation rhinoplasty is one of the most common aesthetic procedures in Asian countries with silicone implant being the most widely used material for augmentation rhinoplasty. Despite potential advantages, use of alloplastic materials in rhinoplasty is often discouraged in Western countries because of concern for possible risk of infection and extrusion of the implant. The collective experience of long-term favorable outcomes in Asia makes the silicone augmentation rhinoplasty a common procedure. Complication rates for silicone implants vary significantly, depending on surgeon experience, surgical technique, and implant design. Silicone implants can be safely used for nasal dorsal augmentation if precautions are taken.
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14
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Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice. Dermatol Surg 2018; 44:53-60. [PMID: 28538034 DOI: 10.1097/dss.0000000000001202] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The numbers of minimally invasive cosmetic procedures performed in the United States have steadily increased each year. Concurrently, the rates of filler complications have also increased. Delayed filler reactions and granulomas have recently been attributed to biofilm infections. OBJECTIVE The biology and pathogenesis of biofilms, and their diagnosis, treatment, and prevention will be discussed. METHODS The relevant and recent literature on delayed filler reactions and biofilms was reviewed. RESULTS Increasing evidence implicates biofilm infections in the pathogenesis of delayed filler reactions. Therapeutic and preventative measures can be taken to minimize the occurrence of these potentially devastating consequences of dermal fillers. CONCLUSION Awareness of biofilm infections is key in the assessment of filler reactions in order to ensure timely and accurate diagnosis and treatment.
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15
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Gall R, Bevans S, Robitschek J. Postoperative Nasal Septal Abscess Following Use of 2-Octylcyanoacrylate and Polydioxanone Plate in Open Septorhinoplasty: A Case Series. Ann Otol Rhinol Laryngol 2017; 126:688-692. [PMID: 28831833 DOI: 10.1177/0003489417727013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The employment of 2-octylcyanoacrylate adhesive (Dermabond) to assist graft placement in open septorhinoplasty has been increasingly used to stabilize cartilage grafts. Literature regarding this application has been mixed, with some showing the possibility of increased rates of inflammation, if not infection. We present an original comparative case series involving postoperative septal abscess formation adjacent to caudal strut grafting where both Dermabond and an absorbable polydioxanone (PDS) plate were used. OBJECTIVE To report an original comparative case series of patients who developed a postoperative septal abscess following open septorhinoplasty in the context of Dermabond application to affix cartilage to a PDS plate to facilitate caudal septal strut grafting. DESIGN Retrospective comparative series with relevant clinical photographs, culture studies, and surgical figures. SETTING Tertiary medical treatment facility. RESULTS Two patients underwent primary open septorhinoplasty with placement of an autologous caudal septal extension graft, which was stabilized using a PDS plate and secured into position using both Dermabond and PDS suture. Postoperatively, both patients presented a nasal septal abscess at an average of 8 weeks that required serial drainage and subsequent removal of the PDS plate in 1 of the patients. Cultures demonstrated mixed flora as well as Proteus mirabilis, previously unreported in the nasal septal abscess literature. In comparison to 8 patients who underwent reconstruction with PDS plate alone (without Dermabond application), this represents a relative risk of 15 ( P value = .053) for a septal abscess complication when Dermabond is employed . CONCLUSIONS We present an original case series on our limited, though impactful experience with PDS plate reconstruction using Dermabond to facilitate caudal septal graft placement in open septorhinoplasty. In conjunction with previously reported case series, which demonstrated elevated risk of prolonged inflammation and infection, we would recommend avoidance of subcutaneous Dermabond as an adjunct, particularly in combination with PDS plate utilization.
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Affiliation(s)
- Ryan Gall
- 1 Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Scott Bevans
- 2 Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jon Robitschek
- 2 Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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16
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Al-Qattan H, Gernsback JE, Nugent AG, Lyapichev KA, Komotar RJ, Chim H. Heterotopic Intracranial Skin Presenting as Chronic Draining Sinus After Remote Craniotomy. World Neurosurg 2016; 98:882.e9-882.e14. [PMID: 27989981 DOI: 10.1016/j.wneu.2016.10.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Craniotomies for trauma are associated with a significant risk of wound complications. We report a case in which a chronic nonhealing draining sinus was caused by an ectopic epidermal lining deep to the craniotomy bone flap, adherent to the underlying dura. CASE DESCRIPTION A 61-year-old man was examined for a 3-year-old, nonhealing scalp wound resulting after a traumatic brain injury. His initial surgery consisted of an intracranial hematoma evacuation through a temporoparietal craniotomy; this was complicated by wound dehiscence and a chronic sinus draining clear fluid that did not resolve with antimicrobial therapy. Intraoperatively, a layer of hair-bearing skin adherent to the dura was found deep to the entirety of the previous bone flap. There was no dura tear or overt cerebrospinal fluid leak. This necessitated removal of the skin over the dura as well as the overlying bone flap. The resultant defect was reconstructed with a titanium mesh and hydroxyapatite cranioplasty, with a scalp rotation flap for coverage of the cutaneous defect. Pathology confirmed skin with intact adnexal structures. CONCLUSION This case demonstrates that it is possible for hair-bearing skin to grow directly on dura, deep to an intact craniotomy bone flap. With a chronic draining sinus in the absence of computed tomography and magnetic resonance imaging findings, this should be part of the differential diagnosis.
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Affiliation(s)
- Husain Al-Qattan
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joanna E Gernsback
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ajani G Nugent
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kirill A Lyapichev
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harvey Chim
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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