Permacol in augmentation rhinoplasty

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series

OBJECTIVE

Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain.

METHOD

The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms.

RESULTS

Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic.

CONCLUSIONS

This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

Corrective Rhinoplasty with Combined Use of Autogenous Auricular Cartilage and Porcine Dermal Collagen in Cleft Lip Nose Deformity

Esthetic reconstruction of cleft lip nose deformity is a challenging task in surgical management of patients with orofacial cleft. The author reconstructed cleft lip nose deformity effectively using autogenous auricular cartilage and a relatively new graft material of porcine dermal collagen, Permacol™. After correction of the deformed lower third of the nose with patient’s auricular cartilage, we applied Permacol™ to augment the entire nasal dorsum. Three patients were treated and followed for up to five years. All patients improved in nose aesthetics without any inflammatory or immunogenic reaction. The author suggests that the use of Permacol™ for nasal profile augmentation in the treatment of cleft lip nose deformity is an alternative surgical strategy with minimal surgical invasiveness. The author report long-term experience with combined use of auricular cartilage and Permacol™ in nasal reconstruction for cleft lip nose deformity.

Soft Tissue Augmentation with Silk Composite Graft

PURPOSE

The objective of this study was to evaluate the interaction between 4-hexylresorcinol (4HR) and antibody as that affects the performance of a silk-4HR combination graft for soft tissue augmentation in an animal model.

METHODS

The silk graft materials consisted of four types: silk+10% tricalcium phosphate (TCP) (ST0), silk+10% TCP+1% 4HR (ST1), silk+10% TCP+3% 4HR (ST3), and silk+10% TCP+6% 4-HR (ST6). The antibody binding assay tested the 4HR effect and scanning electron microscopic (SEM) exam was done for silk grafts. The animal experiment used a subcutaneous pocket mouse model. The graft - SH0 or SH1 or SH3 or SH6 - was placed in a subcutaneous pocket. The animals were killed at one, two, and four weeks, postoperatively. The specimens were subjected to histological analysis and lysozyme assay.

RESULTS

Groups with 4HR applied showed lower antibody binding affinity to antigen compared to groups without 4HR. In the SEM examination, there was no significant difference among groups. Histological examinations revealed many foreign body giant cells in ST0 and ST1 group at four weeks postoperatively. Both ST3 and ST6 groups developed significantly lower levels of giant cell values compared to ST0 and ST1 groups (P <0.001) at four weeks postoperatively. In the lysozyme assay, the ST1 and ST3 groups showed denser signals than the other groups.

CONCLUSION

4HR combined silk implants resulted in high levels of vascular and connective tissue regeneration.

Permacol in eyelid reconstruction -- a novel use

BACKGROUND

Reconstruction of a full-thickness lower eyelid defect is not an uncommon procedure and requires repair of both the anterior and posterior lamella. The modified Hughes procedure is commonly used for large defects, however this requires a second procedure and since the flap must be left in place for at least 3 weeks prior to the second-stage separation, it is not suitable for patients with only eyes or of amblyogenic age. In such situations, a free tarsoconjunctival graft from the opposite upper eyelid or a mucoperiosteal graft from the hard palate is more appropriate. These have the advantage of being autologous tissue with excellent recipient tolerance, however, they are not without drawbacks, including donor site scarring, limited availability and prolonged operating time. In order to avoid donor-site morbidity, several substitutes on the market can be used to replace autologous grafts. Permacol is a relatively new biomaterial made from acellular cross-linked porcine dermal collagen with a structural architecture very similar to that of human dermis.

METHODS

The authors present the first report of the use of Permacol to replace tarsus in the reconstruction of a full-thickness lower eyelid defect.

RESULTS

Permacol seems to be far superior to other commercially available tissue substitutes because of its increased tensile strength, rigidity, durability, predictability of structure and robust behaviour. It is well incorporated by the body, and it serves as an excellent matrix for tissue ingrowth.

CONCLUSION

We feel it is a very good autologous graft substitute in eyelid reconstructive surgery and achieved satisfactory functional and aesthetic results.