注射羟基磷灰石隆鼻术后形态不佳的手术修复

Revision rhinoplasty for poor nasal shape after augmentation by hydroxyapatite

目的探讨羟基磷灰石注射隆鼻后形态不佳,手术修复术的特点和方法。方法2016年1月至2018年12月,北京米扬丽格医疗美容门诊部美容外科就诊羟基磷灰石注射隆鼻形态不佳女性患者62例(年龄20~45岁,平均32岁)要求鼻修复。术前使用三维CT鼻部重建,定位注射物层次及与周围组织关系,术中采用肿胀分离合并夹捏方法去除羟基磷灰石,同期使用膨体-自体腹直肌筋膜复合体隆鼻背,自体肋软骨鼻尖重建。结果62例患者术中无皮肤穿孔,术后无皮肤缺血坏死、无感染及软骨外露发生。随访6~18个月,皮肤厚度增加、无移植物显形、无皮肤凹凸不平、无潮红反应。60例获得满意效果,2例因注射物过于表浅,为保证皮肤血运安全未全部去除,术后皮下可触及散在细小颗粒物,无不适症状,获基本满意效果。结论用肿胀分离+夹捏方法去除羟基磷灰石,同期使用膨体-自体腹直肌筋膜复合体隆鼻背,自体肋软骨鼻尖重建,可获得满意效果。

Objective To report our favorable experience with revision rhinoplasty for dissatisfied appearance of nasal shape after augmentation rhinoplasty by hydroxyapatite(HA).Methods From 2016 to 2018,62 patients(mean age,32 years;range,20-45 years)underwent revision rhinoplasties for poor nasal shape after augmentation by HA.To confirm the plane the foreign substance existed and its relationship with normal tissue of nose,we used three-dimensional CT(CT-3D)reconstruction imaging preoperatively.HA was removed with local tumescent injection and forcep-pinching techniques.After the foreign substance was removed,ePTFE implant was covered by autologous rectus abdominis fascia for dosal augmentation,and nasal tip structure was reconstructed by autologous costal cartilage.Results The follow-up time of the 62 patients was between 6 to 18 months.None patients had the complication of skin necrosis,infection,cartilage exposure,implant visibility,skin irregularity and skin redness.The thickness of the dorsal skin was improved.60 patients were satisfied with the operation results.2 patients were less satisfied because the foreign substances were not removed totally and could be vaguely touched on the skin.The HA in their nose was too close to the skin so we did not remove all of it for fear that the blood supply of the skin would be damaged.Conclusions The local tumescent injection and forcep-pinching techniques for the removal of HA combined with ePTFE implant covered by autologous rectus abdominis fascia for the augmentation of nasal dorsum and autologous costal cartilage for the reconstruction of tip structure could achieve satisfactory results.