Extended trans-dome onlay graft combining nasal vestibule V-Y advancement flap for correction of alar retraction
10.3760/cma.j.cn114453-20220626-00195
- VernacularTitle:肋软骨跨穹窿盖板移植物联合鼻前庭V-Y推进皮瓣矫正鼻翼缘退缩畸形
- Author:
Lei QIN
1
;
Yongsheng ZENG
;
Zhongbo HE
;
Ren LI
Author Information
1. 重庆华美整形外科医院整形科，重庆 400015
- Keywords:
Rhinoplasty;
Alar retraction;
Costal cartilage;
Transplantation, autologous;
Nasal vestibule;
V-Y advancement flap
- From:
Chinese Journal of Plastic Surgery
2022;38(10):1160-1168
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of using extended trans-dome onlay graft(eTDOG) made of costal cartilage combined with nasal vestibule V-Y advancement flap for correction of alar retraction.Methods:Clinical data of patients diagnosed with alar retraction at Chongqing Huamei Plastic Surgery Hospital between July 2019 and October 2020 were retrospectively analyzed. The 6th or 7th right costal cartilage was harvested, cut into pieces for grafts, including a laminar trans-dome onlay graft, made from cortex part of the rib. Then a V-shaped flap was designed on the vestibular skin. At the end of the rhinoplasty, a pocket was created along the alar rim, and the eTDOG was inserted into the pocket to push down the alar rim. Nasal vestibule V-Y advancement flap provides extra soft tissue for alar retraction correction. Splints were applied to hold the eTDOG and flap in place. Assessment of therapeutic effect was made from three aspects. First of all, therapeutic satisfaction assessment, which was made based on the visual analogue scale(VAS). VAS scoring was conducted by patients and two surgeons who were not involved in surgery. Results were divided into three categories, total satisfaction with scoring 9 or 10, partly satisfaction with scoring 7 or 8, and dissatisfaction with scoring 0-6. Subsequently, the percentage of satisfaction indeed in the total number of cases was counted. Alar symmetry assessment was also included. The percentage of cases with alar symmetry in the total number of cases. Third, the ratio (a/b) of the distance between the line defined by bilateral highest points of alar retraction and the line determined by tip-defining points (a) to that between the line determined by bilateral highest points of alar retraction and the horizontal line defined by the turning point of columella lobule (b) was calculated on frontal view. The value of a and b was measured using Image J, and a/b<1 represented absence of alar retraction. The statistical analysis was performed using SPSS version 20.0. Chi-square test was used to compare the symmetry of alae pre- and post-operation. Values of a/b were expressed as Mean±SD, and was compared using t-test. SNK were used for comparison among and between groups of different types, respectively. P-value less than 0.05 considered to be statistically significant. Results:Forty-three cases were included in this study, including 5 men and 38 women, with mean age of 27.3 years (18-45 yars). Among them, medial, central and lateral type of alar retraction was comprised of 17, 22 and 4 cases, respectively. The median follow-up time was 4 months (range, 1-24 months). During the follow-up, no complications like avascular necrosis of ala, step like deformity or alar contracture were observed, so was the recurrence of alar retraction. A total of 5 complications were observed, including 4 cases of hypertrophic scar at the incision which were improved after injection of Triamcinolone and 1 case of remaining alar asymmetry which was corrected by reoperation. The VAS score of patient was 8.93±1.12, and patients with satisfaction indeed accounted for 81.4% (35/43). The mean VAS score of the two operation-non-participated surgeons was 8.93±1.04; and cases assessed to be satisfaction indeed accounted for 81.4% (70/86). The proportion of symmetric alae significantly improved from 58.1% (25/43) to 93.0% (40/43) ( P<0.01). The ratio of a/b decreased from 0.79±0.06 pre-operation to 1.00±0.04 post-operation( P<0.01). While no significance was found among groups neither pre- nor post-operation ( P>0.05). Conclusions:eTDOG made of costal cartilage combining nasal vestibule V-Y advancement flap is an effective method for correction of all types of alar retraction and improvement of alar symmetry, with high satisfaction of patients and surgeons.
