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Huang X, Gan Y, Xia X, Gu T, Peng S, Wu J, Chen X, Liang Y, Guo Z, Lin J. Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report. Aesthetic Plast Surg 2024:10.1007/s00266-024-04052-8. [PMID: 38831066 DOI: 10.1007/s00266-024-04052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications. OBJECTIVE To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE. METHODS A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups. RESULTS No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups. CONCLUSION Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP. LEVEL OF EVIDENCE I 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)
- Xin Huang
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Yufeng Gan
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Xiaofeng Xia
- Department of Plastic Surgery, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, No.4 Guihua Road, Hangzhou, 311400, Zhejiang, China
| | - Tianya Gu
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Su Peng
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Jie Wu
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Xiang Chen
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Yan Liang
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China
| | - Zongke Guo
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, No.87 Dingjiaqiao, Nanjing, Jiangsu, China.
| | - Jinde Lin
- Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, No.146 Hanzhong Road, Nanjing, 210009, Jiangsu, China.
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Peng S, Huang X, Gu T, Liang Y, Yu L, Wu J, Guo Z, Lin J. Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty. J Craniofac Surg 2023; 34:2082-2086. [PMID: 37254241 DOI: 10.1097/scs.0000000000009391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/27/2023] [Indexed: 06/01/2023] Open
Abstract
Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7 mm) was significantly improved (35.6±5.7 mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3 mm preoperatively to 25.3±2.4 mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.
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Affiliation(s)
- Su Peng
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Xin Huang
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Tianya Gu
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Yan Liang
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Lei Yu
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Jie Wu
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
| | - Zongke Guo
- Department of Plastic Surgery, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
| | - Jinde Lin
- Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University
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Long-Term Resorption Rate of Autogenous Onlay Graft in East Asian Rhinoplasty: A Retrospective Study. Plast Reconstr Surg 2022; 149:360-371. [PMID: 35077410 DOI: 10.1097/prs.0000000000008793] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autologous material remains the preferred graft material for use in rhinoplasty. However, resorption rates of autografts remain controversial. In addition, long-term follow-up studies on autografts are rare. Thus, the objective of the present study was to access long-term resorption rates of various autologous grafts on the upper nasal third. METHODS Medical records of patients who had undergone septorhinoplasty with dorsal augmentation using autologous tissues between 2009 and 2018 were retrospectively reviewed. Autogenous grafts applied on the nasal dorsum were categorized into three groups: rolled superficial mastoid fascia, diced cartilage wrapped with superficial mastoid fascia, and rolled sacral dermis. Preoperative and postoperative photographs were used to evaluate resorption rates and projection. RESULTS The rolled sacral dermis group showed a steep increase in postoperative projection but a sharp decrease in long-term follow-up projection compared to the other two groups. Among these three groups, there were statistically significant trend differences in rhinion (p < 0.001) and ½ nasion-rhinion point (p < 0.001), but not in nasion. Of these three groups, the rolled sacral dermis group showed the most projection, followed by the diced cartilage wrapped with superficial mastoid fascia group. The resorption rate was the highest in the rolled superficial mastoid fascia group (p < 0.001). Regarding resorption rates in the other two groups, the rolled sacral dermis group had a higher rate than the diced cartilage wrapped with superficial mastoid fascia group. CONCLUSIONS At least 50 percent of resorption was observed in almost all groups in the long term. The choice of graft material and proper decision-making could determine success or failure. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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