Nueva alternativa para relleno y camuflaje de dorso nasal: Injerto mixto de L-PRF y cartílago / New alternative for filling and camouflage of nasal dorsum: Mixed graft of L-PRF and cartilage

RESUMEN Introducción: Entre las alteraciones del dorso nasal puede encontrarse desde un rádix bajo hasta un aplastamiento severo del dorso nasal, siendo fundamental el uso de injertos y material de relleno. Objetivo: Proponer una nueva alternativa de relleno y camuflaje en rinoplastía mediante un injerto mixto de L-PRF más cartílago picado en una matriz de fibrina autóloga. Material y método: Evaluación de los pacientes operados de rinoseptoplastía en quienes se utilizó el injerto mixto entre febrero y septiembre del año 2016 en el Servicio de Otorrinolaringología del Hospital Regional de Concepción. Evaluación de resultados respecto a reabsorción e irregularidades del injerto y autoevaluación del grado de satisfacción. Resultados: Fueron operados 7 pacientes. Cuatro de ellos presentaban aplastamiento severo de dorso nasal y tres un rádix profundo. Se logró el relleno y camuflaje del área deseada en todos los casos. No se presentó desplazamiento ni reabsorción del injerto en ninguno de los casos. El uso de este injerto no significó mayor costo económico, y el grado de satisfacción fue alto en todos los casos. Conclusión: Primer estudio en utilizar un injerto mixto de cartílago más L-PRF en una matriz de fibrina autóloga en rinoplastía, demostrando ser una alternativa asequible, efectiva, reproducible y segura, particularmente útil en casos de revisión.

ABSTRACT Introduction: Among the alterations of the nasal dorsum there can be found from a low radix to a severe crushing of the nasal dorsum, being fundamental the use of grafts and filling materials. Aim: To propose a new filling and camouflage alternative in rhinoplasty by means of a mixed graft of L-PRF and chopped cartilage in an autologous fibrin matrix. Material and method: Evaluation of the operated patients of rhinoseptoplasty in whom the mixed graft was used between February and September 2016 in the Otorhinolaryngology unit of the Hospital Regional de Concepción. Evaluation of results regarding resorption and graft irregularities and self-assessment of degree of satisfaction. Results: Seven patients were operated. Four of them presented severe crushing of the nasal dorsum and three of them a deep radix. The filling and camouflage of desired area was achieved in all cases. There were no displacement or resorption of the graft in any case. The use of this graft did not mean greater economic cost, and the degree of satisfaction was high in all cases. Conclusions: First study to use a mixed graft of cartilage and L-PRF in an autologous fibrin matrix in rhinoplasty, proving to be an affordable, effective, reproducible and safe alternative, particularly useful in revision surgeries.

Rhinoplasty using Various Autogenous Tissues

PURPOSE: In Korean rhinoplasty, alloplasts such as silicone rubber have been used for dorsal and tip augmentations. However, alloplasts have produced complications such as deviation, exposure, and infection. Although autogenous tissue is an ideal material, the amount of the cartilage in Korean is not sufficient. Therefore, the authors developed a method to harvest the maximum amount of the septal and conchal cartilage. The authors first performed a complete septal extension graft for short and retruded columella and then performed nasal augmentation using various autogenous tissues. METHODS: These surgical techniques were performed on 11 patients. Their average age was 27 years. An open approach with a V-shaped columellar labial incision was performed. At first, the complete septal extension graft was fixed on the entire caudal margin of the septum, and the alar cartilage was suspended to the septal extension graft to make the tip projected and the columella advanced caudally. A temporal fascial ball was used for radix augmentation. For dorsal augmentation, a batten-shaped septal cartilage graft wrapped with or without the temporal fascia or a diced cartilage graft wrapped with the temporal fascia was performed. For nasal tip augmentation, a shield graft and a cap graft or a folded conchal cartilage graft was performed. RESULTS: The mean follow-up period was 11.2 months. The overall results were natural and satisfactory. Two patients underwent slight absorption and caudal displacement. With the exception of these cases, no complications were observed. CONCLUSION: Korean rhinoplastic surgeons are accustomed to using the alloplasts despite of serious complications. When rhinoplasty using autogenous tissue was performed, some complications occurred such as the displacement of the diced cartilage graft wrapped with the fascia, but many of the complications of alloplastic rhinoplasty were avoided. Therefore, we propose that by this time Korean rhinoplastic surgeons need to change their preference from alloplastic rhinoplasty to autogenous rhinoplasty.

Dorsal Augmentation in Secondary Rhinoplasty

Two most common pathologic mechanisms which cause secondary rhinoplasty are related with nasal framework and it's envelope. The reasonable definition defining key features of the secondary rhinoplasty 'Scarred nasal soft tissue envelope overlying adherent and distorted nasal framework' gives full explanation about main deformities in the secondary rhinoplasty, and leads us to focus on reconstructing and reinforcing both structures when the secondary rhinoplasty is performed. Moreover, artificial alloplastic implants and injectable materials, popularly used for augmentation rhinoplasty, erode skin and give damages to skin and appendages. It is, therefore, essential to understand the importance of skin problem and to know that one must be ready to suffer from another more difficult operations and its unpredictable results, unless it is properly reinforced. I have used several autogenous materials (n=294) and two kinds of xenografts (n=35) in the secondary rhinoplasties during the last 8 years for reinforcing the envelopes in pathologic conditions and augmenting the dorsal volume. I have learned a lesson from these 8 years of experience about dorsal augmentation in secondary rhinoplasty. 1) Even though it seems to be time consuming and annoying to harvest and prepare autogenous graft materials, no xenografts or artificial materials are safer and more consistent than autogenous materials, and no convenience is more valuable than consistency and safety in secondary rhinoplasty. 2) If you need to augment nasal dorsum in secondary rhinoplasty, get the permission from the nasal envelope. 3) Remind this aphorism: Alloplastics are only convenient on the day of surgery.