鼻中隔延伸移植物钻孔方法在自体肋软骨鼻整形术中的应用

Application of nasal septum extension graft drilling technique in rib-based rhinoplasty

目的:探讨一种软骨移植物固定方法在自体肋软骨鼻整形术中的临床应用效果。方法:回顾性分析2020年1月至2022年1月中国医学科学院整形外科医院鼻整形与再造中心收治的行肋软骨鼻整形术患者的临床资料。术中在放置鼻中隔延伸移植物之前,预先利用20 ml注射器针头对软骨片移植物进行钻孔处理,使得软骨移植物表面散布若干直径约1 mm的微孔,制备出"带有微孔的鼻中隔延伸移植物"。术中其他移植物的制备依常规方法进行。术后对鼻整形效果及并发症情况进行观察随访。结果:共纳入30例女性患者,年龄21~45岁,平均36岁,均为初次或修复的自体肋软骨隆鼻患者,鼻中隔软骨未遭到严重的破坏(至少保留大于10 mm的L形支架)。手术均进展顺利,软骨支架稳定持久,术后无感染、鼻中隔血肿、软骨外露等严重并发症发生。术后患者均随访6~24个月,2例患者因术后外观不满意(1例因为鼻尖长度及鼻尖旋转度不满意;1例由于术后3个月鼻背软骨显形),进行了二次修复调整手术,术中打开分离鼻中隔黏软骨膜,探查可见钻孔处明确的类似黏膜组织的长入,进一步验证了钻孔操作的作用。其余患者均对术后效果满意。结论:基于钻孔技术的鼻中隔延伸移植物,有利于维持肋软骨鼻综合整形手术后软骨支架的长期稳定性,值得推广应用。

ObjectiveTo investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.MethodsThe clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed.A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement."septal extension grafts with micropores"were prepared,and the preparation of the remaining grafts was conventional.ResultsA total of 30 female patients aged 21-45 years,with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage(at least retention of L-shaped scaffolds larger than 10 mm)were enrolled.All operations were successful,the cartilage scaffold was stable and durable.There were no serious complications such as infection,septal hematoma and cartilage exposure.Postoperative patients were followed up for a duration of 6-24 months.Two out of 30 patients were not satisfied with the postoperative appearance.During the revision surgery,the septal perichondrium was separated,mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling.The other patients were satisfactied with the results.ConclusionNasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery,which justifies its application in comprehensive nasal plastic surgery.