Porous Polyethylene Implants In Secondary Revision Of Rhinoplasty: A Safer Procedure?

摘要

Revision rhinoplasty is one of the most challenging operations in facial surgery. Not only is a surgical procedure being performed on a scarred facial structure, which limits overall success, but also the patient undergoing revision rhinoplasty often has unrealistic expectations of the final results. Revision rhinoplasty has stimulated a variety of reconstructive techniques by surgeons dedicated to restoration of both nasal form and nasal function. Supportive materials are widely used in this operation. These materials may be categorized as autogenous tissue, homograft materials, and alloplastic materials. In this study we present our experience with high density porous polyethylene (HDPP) in thirteen patients who had operated for aesthetical revision rhinoplasty with autogenous tissue before. HDPP implants were used in nasal dorsum in aesthetical revisions. We detected only one complication as implant malposition. We speculate that prior augmentation of the nasal dorsum forms a pre-expanded nasal skin and increases the vascularity of the region. Rasping of the nasal dorsum increases the bare contact surface adding to tissue ingrowth to the implant and stabilization of it. Scar tissue due to prior surgery and subperiosteal placement of the implant increases the barrier effect of the nasal skin. Although autogenic materials should be preferred in nasal dorsal augmentation, in secondary cases in which donor area limitations are encountered, HDPP implants can easily and effectively be used for nasal dorsum augmentation. Introduction Revisions in aesthetic rhinoplasty may be due to problems in surgical technique, insufficient evaluation of the patient, unrealistic expectations of the patient or problems in wound healing and scar formation (1,2,4,11). The rate for revision rhinoplasty in the literature are between %5-10 in different publications (1,2,4).Revision rhinoplasty has stimulated a variety of reconstructive techniques by surgeons dedicated to restoration of both nasal form and nasal function. Supportive materials are widely used in these operations. These materials may be categorized as autogenous tissue, homograft materials, and alloplastic materials (3). Since in revision rhinoplasty it is advisable to replace missing or scarred structures with similar tissue, cartilage grafts are accepted as “golden standard”(15). Although autogenous bone and cartilage offered the advantage of tissue compatibility, they had their drawbacks: donor site morbidity, restricted availability, difficulty of shaping the graft, unpredictability of remodeling, and resorption. High density porous polyethylene (HDPP) has been used successfully in rhinoplasty for many years(5,8,9,10,12,13,14,16). The nose is a difficult area for implantation because of the thinness of the tissue, the proximity of potentially contaminated mucosa, the prominence and mobility of the nose, and the fact that most cases requiring augmentation involve previous injury or surgery (5). In this study we present our experience with HDPP in thirteen patients who were operated for secondary aesthetical revision rhinoplasty. Materials and Methods Thirteen secondary aesthetic revision rhinoplasty patients in whom high density porous polyethylene (HDPP) implants were used in secondary revision of rhinoplasty in Adnan Menderes University Department of Plastic, Reconstructive and Aesthetic Surgery were evaluated. All patients had at least one revision rhinoplasty in which dorsal cartilage grafts were used before. The patients had their first operations in different institutions and departments. All patients were operated under general anesthesia with transcolumellar inverted V incision and open rhinoplasty. After extensive exposition of the nasal dorsum, remnants of the former operation, forming irregularities, in form of cartilage or bone were removed. Nasal dorsum was rasped and custom made HDPP blocks were sculptured with No 15 scalpel. The formed HDPP implants were inserted into s