Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty

Background:

Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. “Warping” can also be utilized to change the curvature of the graft.

Materials and Methods:

We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.

Results:

All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.

Conclusion:

The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.KEY WORDS: Autogenous cartilage, balanced section, costal cartilage graft, rhinoplasty, warping     

块状肋软骨移植物在隆鼻术中矫正鼻基底凹陷的临床效果

分析块状肋软骨移植物在隆鼻术中对鼻基底凹陷患者的矫正效果。方法 选择2021年 5月-2023年5月于我院行隆鼻术的100例鼻基底凹陷患者为研究对象，采用随机数字表法分为对照组和 观察组，各50例。对照组行颗粒状肋软骨矫正，观察组行块状肋软骨矫正，比较两组鼻部美学角度测 量值、并发症发生情况及满意度。结果 观察组小柱上唇角、小柱小叶角、鼻面角及鼻额角均高于对照 组，差异有统计学意义（P ＜0.05）；观察组并发症发生率为4.00%，低于对照组的20.00%，差异有统计 学意义（P ＜0.05）；观察组满意度为100.00%，高于对照组的80.00%，差异有统计学意义（P ＜0.05）。结 论 块状肋软骨移植物在隆鼻术中矫正鼻基底凹陷的临床效果良好，能够改善患者的凹陷症状，提高鼻部 美学效果，且术后并发症发生几率较低，患者满意度较高。     

肋软骨与耳软骨联合硅胶假体隆鼻效果比较

目的:比较耳软骨联合硅胶假体与肋软骨联合硅胶假体隆鼻的应用效果。方法:收集2017年7月1日-2018年12月31日笔者医院收治的鼻整形患者160例,随机按1:1比例分为对照组(n=80)与观察组(n=80),对照组采取耳软骨联合硅胶假体隆鼻,观察组采取肋软骨联合硅胶假体隆鼻,比较两组患者手术时间与愈合时间,术后随访6个月比较两组鼻整形效果满意度,鼻部外观相关指标改善情况以及并发症发生的变化情况。结果:两组手术时间与愈合时间比较差异无统计学意义(P>0.05)。术后随访6个月,两组鼻唇角、鼻额角、鼻尖长度、鼻尖突出率以及面部突出度明显改善,差异有统计学意义(P<0.05);观察组鼻唇角、鼻尖突出率以及面部突出度改善幅度更佳,差异具有统计学意义(P<0.05)。观察组并发症发生率为3.75%低于对照组的15.00%,总满意度为93.75%明显高于对照组的77.50%,差异有统计学意义(P<0.05)。结论:肋软骨联合硅胶假体隆鼻相比于耳软骨联合硅胶假体在鼻部整形美学角度改善方面具有更好的效果,术后并发症少,值得临床推广。     

History of Chinese stereotactic and functional neurosurgery

Chinese stereotactic and functional neurosurgery started in 1963. Dr. Jian-Ping Xu did stereotactic surgery for Parkinson's disease with a small Cartesian coordinate stereotactic device which he designed. In 1983, the first Chinese Institute of Stereotactic and Functional Neurosurgery was established by Dr. Jian-Ping Xu and Dr. Ye-Han Wang in the Anhui Provincial Hospital in the city of Hefei. Since then, the Institute has hosted an annual National Workshop on Stereotactic and Functional Neurosurgery, where more than 80% of the functional neurosurgeons now practicing in China have been trained. In 1986, the Chinese Society of Stereotactic and Functional Neurosurgery was established, and the first issue of the Chinese Journal of Stereotactic and Functional Neurosurgery was published. With more than 35 years of development, stereotactic and functional neurosurgery has become a very important branch of surgery in China. More than 5,000 functional neurosurgery procedures and more than 8,000 stereotactic radiosurgery procedures are now performed annually.     

闭合式入路自体肋软骨颗粒移植隆鼻术的美学效果

目的 探讨闭合式入路自体肋软骨颗粒移植隆鼻术的美学效果。方法 选择2019年10月-2022年 10月我院收治的90例隆鼻患者为研究对象，根据采用术式的不同分为对照组和研究组，每组45例。对照 组实施膨体聚四氟乙烯假体植入隆鼻，研究组实施闭合式入路自体肋软骨颗粒移植隆鼻，比较两组美学 效果、鼻面角度相关指标、并发症发生率及患者满意度。 结果 研究组美学总有效率为95.56%，高于对照 组的77.78%，差异有统计学意义（P＜0.05）；研究组术后6个月鼻额角、鼻面角与鼻尖凸度均高于对照 组，差异有统计学意义（P＜0.05）；研究组并发症发生率为4.44%，低于对照组的17.78%，差异有统计学 意义（P＜0.05）；研究组患者满意度为95.56%，高于对照组的77.78%，差异有统计学意义（P＜0.05）。 结 论 与膨体聚四氟乙烯假体植入隆鼻术相比，闭合式入路自体肋软骨颗粒移植隆鼻术更有利于提高美学效 果，改善患者鼻面角度相关指标，降低并发症发生率，提升患者满意度，值得临床应用。     

Irradiated homologous costal cartilage for augmentation rhinoplasty

Although the ideal reconstructive material for augmentation rhinoplasty continues to challenge plastic surgeons, there exists no report in the literature that confines the use of irradiated homologous costal cartilage, first reported by Dingman and Grabb in 1961, to dorsal nasal augmentation. The purpose of this paper is to present a retrospective analysis of the author's experience using irradiated homologous costal cartilage in augmentation rhinoplasty. Twenty-seven dorsal nasal augmentations were performed in 24 patients between 16 and 49 years of age with a follow-up ranging from 1 to 27 months. Good-to-excellent results were achieved in 83.3% (20 of 24). Poor results requiring revision were found in 16.7% (4 of 24). Complication rates included 7.4% infection (2 of 27) and 14.8% warping (4 of 27). The resorption rate was zero. These results compare favorably with other forms of nasal augmentation. Advantages and disadvantages of irradiated homologous costal cartilage are discussed.     

自体肋软骨移植综合鼻成形术

目的探讨应用自体肋软骨移植行综合鼻成形术的方法,观察手术效果。方法鼻部应用开放切口．取自体肋软骨移植行综合鼻成形术。截取6～7cm长第6或7肋软骨用于结构移植：（1）雕刻成柳叶形鼻背移植物用于隆鼻术;（2）雕刻成长条形鼻小柱支撑移植物用于鼻小柱支撑及鼻延伸术;（3）雕刻成盾牌形移植物用于鼻尖成形术。结果52例患者均获得满意的鼻背及鼻尖美学效果。鼻背轮廓线、鼻尖表现点、鼻尖上区转折清晰。无移植物外露、移位、软骨变形。亦未见气胸、感染、血肿等并发症发生,胸壁瘢痕不明显,效果满意。结论应用自体肋软骨移植行综合鼻成形术,可以满足对假体存在心理排斥的患者的求美需求,亦可为二次或多次鼻成形术后畸形的患者提供足够的自体修复材料,并大大的降低了再次手术感染的风险。其效果良好,并发症少,值得推广。     

改良倒“L”法内眦赘皮矫正术联合切开法重睑术的临床效果

目的 探究肋软骨皮质搭建支架在鼻整形术中的应用效果。方法 选取2021年5月-2022年8月于 本院行鼻整形术的60例患者为研究对象，采用随机数字表法分为对照组和观察组，各30例。对照组给予硅 胶材料搭建支架，观察组给予肋软骨皮质搭建支架，比较两组愈合情况、整形满意度、鼻部三维指标（鼻 尖突度、鼻长、左右鼻尖顶点间距）、鼻部美学指标（鼻唇角、鼻面角、鼻额角）、鼻通气功能（鼻腔容 积差值、鼻腔最小横截面积差值、鼻腔呼气吸气阻力差）、生活质量（术后心理健康、社会功能）及并 发症发生情况。结果 观察组愈合优良率为100.00%，高于对照组的86.67%（P＜0.05）；观察组对鼻尖、鼻 形、鼻孔的整形满意度评分均高于对照组（P＜0.05）；观察组鼻尖突度、鼻长、左右鼻尖顶点间距均优于 对照组（P＜0.05）；观察组鼻唇角、鼻面角、鼻额角均优于对照组（P＜0.05）；观察组术后心理健康、社 会功能评分均高于对照组（P＜0.05）；观察组并发症总发生率低于对照组（P＜0.05）。结论 肋软骨皮质 搭建支架在鼻整形术中的临床应用效果优于硅胶材料搭建支架，可促进切口愈合，改善鼻部形态，有利于 提高患者的整形满意度和生活质量，且术后并发症发生几率较小，安全性较高，值得临床应用。     

Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

BackgroundThe corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene (ePTFE) in Asian rhinoplasty were presented in this study.ObjectivesThe purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.MethodsSeventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed. Graft types, complications associated with the graft itself or graft harvesting, surgical outcomes, and patient satisfaction were assessed.ResultsThe mean follow-up time post-operation was 13.5 months. A total of 42/75 patients underwent revision surgeries. Graft-related complications were found in 8% of cases, including two warped graft and four infection cases. Three individuals with infections had mild graft resorption. One patient with an infection removed the implant. Graft exposure, mobility, and substantial resorption were not recorded. A total of two cases underwent revision procedures for infection and perforation, respectively. Chest incision lengths for graft harvesting averaged 2.1 cm. No pneumothorax or significant donor-site pain was found. Donor-site scars were negligible, although two cases had hypertrophic chest scars. In general, functional and esthetic outcomes were mostly satisfactory among the assessed patients.ConclusionsRhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring. Meanwhile, ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes. Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent, long-lasting results with minimal risk; however, the potential for infection should be considered following revision surgery.     

自体软骨联合膨体聚四氟乙烯应用于鼻综合整形中的效果

目的 探讨自体肋软骨联合膨体聚四氟乙烯应用于鼻综合整形中的临床疗效。方法 选取2019年 11月-2022年11月我院收治的100例鼻综合整形患者为研究对象,根据不同手术方式分为对照组与研究组, 各50例。对照组采用膨体聚四氟乙烯填充,研究组采用自体肋软骨联合膨体聚四氟乙烯填充,比较两组临 床疗效、愈合情况、鼻部相关参数、不良反应发生率及满意度。结果 研究组治疗总有效率为96.00%,高 于对照组的80.00%（P＜0.05）;研究组愈合时间短于对照组,完全愈合率高于对照组（P＜0.05）;研 究组鼻尖突出度、鼻背长度、小柱-小叶比、鼻额角、鼻根部的鼻梁高度均优于对照组（P＜0.05）;研 究组不良反应发生率为4.00%,低于对照组的20.00%（P＜0.05）;研究组满意度为96.00%,高于对照组 的78.00%（P＜0.05）。结论 自体肋软骨联合膨体聚四氟乙烯可有效提高鼻综合整形效果及愈合效果,改 善鼻部相关参数,且并发症少,患者满意度高。     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的应用

的 探讨予以鼻整形手术患者自体肋软骨移植构建鼻尖软骨复合体治疗的临床价值。方法 选 取2021年4月-2022年10月于南昌诺颜医疗美容医院行鼻整形手术的200例患者为研究对象，通过奇偶法 分为试验组和对照组，每组100例。试验组采用自体肋软骨移植构建鼻尖软骨复合体，对照组采用常规 材料复合体，比较两组鼻部美学角度测量值、患者满意度及并发症发生率。结果 试验组鼻唇角、鼻面 角、额鼻角水平均高于对照组（P＜0.05）；两组鼻背高度比较，差异无统计学意义（P＞0.05）；试验组 鼻部外形、鼻部高度及整体满意度评分均高于对照组（P＜0.05）；试验组并发症发生率为3.00%，低于 对照组的13.00%（P＜0.05）。结论 将自体肋软骨移植构建鼻尖软骨复合体用于鼻整形手术中的效果较为 理想，可有效改善鼻部形态，且患者满意度高，不良反应少。     

腹腔镜胃肠肿瘤手术的进展

Since Dr.Mouret first introduced the laparoscopic technique into chokcystectomy,a new surgical era has arrived.With the rapid development of minimally invasive technique,it is now playing an important role in the surgical treatment of gastrointestinal cancers.Almost all kinds of gastric operations,such as wedge resection,distal gastrectomy,proximal gastrectomy and total gastrectomy with or without lymph node resection can be achieved with a laparoscope.In China,laparoscopic gastrectomy has been widely applied in many experienced medical centers and great progress has been achieved in the treatment of early and advanced gastric cancer.Laparoscopic colonic surgery has been recognized as one of the standard operations by NCCN.In Asian countries like China,Japan and Korea,laparoscopic rectal surgery following the TME principle has been widely applied.Because of the rapid development of laparoseopic gastrointestinal surgery in China,the Chinese Society of Laparoendoscopic Surgery has published standardized guidelines and established training centers for the development of young Surgcons.     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的应用效果

目的 探究自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的应用效果。方法 选取2021年 1月-2022年6月我院收治的150例鼻整形患者作为研究对象，随机分为对照组及研究组，每组75例。对照 组单纯利用膨体聚四氟乙烯假体，研究组进行自体肋软骨移植构建鼻尖软骨复合体，比较两组手术前后 的鼻尖突出度、创面愈合时间、愈合程度、不良反应发生情况以及整形满意度。结果 研究组创面愈合时 间短于对照组，差异有统计学意义（P＜0.05）；研究组术后鼻尖突出度高于对照组，差异有统计学意义 （P＜0.05）；研究组不良反应发生率低于对照组，愈合程度优于对照组，差异有统计学意义（P＜0.05）； 研究组整形满意度评分高于对照组，差异有统计学意义（P＜0.05）。结论 自体肋软骨移植构建鼻尖软骨 复合体在鼻整形中的应用效果较好，能够呈现出较为自然的鼻形状态，患者认可度更高。     

The decision process in choosing costal cartilage for use in revision rhinoplasty

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.     

Neurosurgery at the Hadassah-Hebrew University Medical Center in Jerusalem

Henrietta Szold founded the Hadassah Women's Organization in the United States in 1912 to alleviate widespread disease and poverty in Jerusalem. In 1918, the Rothschild-Hadassah Hospital and the Hadassah School of Nursing opened in central Jerusalem. Chaim Weizmann and Albert Einstein, together with a small group of visionaries, founded the Hebrew University in 1923. After 1933, many physicians and scientists fled from Europe to Jerusalem, where they carried on their tradition of academic research at the university and Hadassah, and British military doctors joined medical rounds and lectures at Hadassah beginning in the 1930s. Young physicians who had graduated from European medical schools were trained in the subspecialties at Hadassah beginning in the 1940s, and the Hebrew University-Hadassah Medical School enrolled its first class in 1949. These were the first academic institutions of their kind in Israel. The Department of Neurosurgery at Hadassah was established in 1941 under the leadership of Dr. Henry Wigderson, who was recruited from the United States. Dr. Aaron Beller became chairman in 1951, Dr. Mordechai Shalit became chairman in 1977, and Dr. Felix Umansky, the current chairman, was appointed in 1993. Today, more than 900 neurosurgical procedures spanning the spectrum of subspecialties and using state-of-the-art techniques and equipment are performed annually.     

Asian rhinoplasty

Asian rhinoplasty presents unique challenges to the surgeon. The aesthetic goals should be tailored for the ethnicity and culture of the individual patient. Unlike typical Caucasian rhinoplasty, primary Asian rhinoplasty is frequently augmentation rhinoplasty. Alloplastic implants have had a long history of safety in Asia, but many patients are not suitable for or not agreeable to the use of alloplastic materials and autologous costal cartilage should be considered. This procedure is safe and reliable when these techniques are properly executed.     

Ilizarov技术在中国大陆20年(1991～2011年)

[目的]介绍Ilizarov技术在中国大陆的引进与发展情况.[方法]以在中国已发表有关Ilizarov技术医学论文及会议记录为研究对象.采用电子检索和手工检索,或与有关作者联系相结合,按照制定的检索策略,由两名研究人员进行背对背检索,通过阅读文献的题目及摘要进行初筛结果的检索,然后阅读全文,依据纳入和排除标准独立纳入每一篇论文,去除交叉重合文献及与该课题无关的文献.对每个纳入的文献进行分析.[结果](1)Ilizarov技术引入中国的途径源于俄罗斯、日本、北美、欧洲(主要是意大利、英国);(2)中国学术期刊发表的相关论文1994年出现高峰,2000年后依次递增;(3)刊登Ilizarov相关文章数量前十名的杂志:《中国矫形外科杂志》65篇;《中华小儿外科杂志》24篇;《中国骨伤杂志》14篇;《中华创伤骨科杂志》14篇;《中华骨科杂志》13篇;《中华外科杂志》9篇;《临床骨科杂志》8篇;《中国组织工程研究与临床康复》7篇;《实用骨科杂志》6篇;《中国骨与关节损伤杂志》6篇;(4)国内单位发表的有关Ilizarov的SCI文章:湘雅医院5篇;上海交通大学附属医院3篇;北京积水潭医院2篇;第四军医大学1篇;中国医科大学1篇;同济大学1篇;(5)发表Ilizarov相关文章数量前十名作者(第一作者):秦泗河51篇;吴其常12篇;赵宝权8篇;楼跃6篇;陈建文6篇;邓京城6篇;夏和桃4篇;许瑞江4篇;夏榕圻4篇;张群4篇;(6)论文他引用率最高的前10篇论文,其中秦泗河占了8篇,整形外科论文1篇.[结论]Ilizarov技术于20世纪80年代从不同的境外引入中国,随着相关培训班的举办,国际学术会议的交流,国内学习、应用Ilizarov技术的骨科与整形外科医生呈明显增多趋势.秦泗河、夏和桃医生和《中国矫形外科杂志》对Ilizarov技术在中国的临床应用与学术推动,做出了历史性贡献.     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形手术中的美学效果

目的 探究鼻整形手术中鼻尖软骨复合体采用自体肋软骨移植构建的美学效果。方法 选取2022年 7月-2023年7月于我院进行鼻整形的患者169例,按照随机数字表法分为A、B两组,A组84例,B组85例。 A组构建鼻尖软骨复合体时使用膨体聚四氟乙烯材料,B组使用自体肋软骨材料,比较两组外观满意度、鼻 唇角、鼻面角、额鼻角及鼻背高度测量值。结果 B组外观满意度为87.06%,高于A组的57.14%（P＜0.05）;两 组治疗后鼻唇角、鼻面角、额鼻角均高于治疗前,且B组高于A组（P ＜0.05）;两组治疗后鼻背高度均高 于治疗前（P ＜0.05）,但两组治疗后鼻背高度比较,差异无统计学意义（P ＞0.05）。结论 鼻整形手术中 鼻尖软骨复合体采用自体肋软骨移植构建可提升外观满意度,增加鼻唇角、鼻面角、额鼻角及鼻背高度。     

自体肋软骨联合硅胶假体鼻整形效果探讨

目的:探讨自体肋软骨联合硅胶假体在鼻整形中的应用效果。方法:回顾性分析2015年5月-2017年5月笔者医院接受鼻整形的105例就医者临床资料,通过治疗方式不同分为观察组55例和对照组50例,对照组使用硅胶假体隆鼻,观察组使用自体肋软骨联合硅胶假体隆鼻,比较两组手术情况、鼻部塑形效果、二次手术率及并发症发生情况。结果:两组手术成功率、愈合时间比较,差异无统计学意义(P>0.05);观察组手术时间明显长于对照组,差异有统计学意义(P<0.05)。和术后3个月时比较,观察组术后12个月时鼻根高、鼻面角、鼻尖角、鼻额角差异无统计学意义(P>0.05);对照组术后12个月时鼻根高、鼻面角、鼻尖角均明显降低(P<0.05),且术后12个月时,观察组鼻根高、鼻面角、鼻尖角均明显高于对照组(P<0.05)。观察组二次手术率为3.64%(2/55)明显低于对照组的16.00%(8/50),差异有统计学意义(χ^2=4.646,P=0.031)。观察组术后并发症总发生率为14.55%明显低于对照组的32.00%,差异有统计学意义(P<0.05)。结论:和单用硅胶假体相比,自体肋软骨联合硅胶假体用于鼻整形中效果更加显著,具有鼻部塑形效果满意、二次手术率低、并发症少等特点,临床应用价值高。     

Structural grafting in rhinoplasty

Many surgeons consider cosmetic rhinoplasty to be one of the most challenging facial plastic surgical procedures. Open-structure rhinoplasty allows for visualization of bony-cartilaginous deformities, preservation of nasal structural integrity, and precise nasal reshaping. The ultimate, external appearance of the nose is the sum of the interaction of the bony-cartilaginous skeleton and the skin soft-tissue envelope. This article describes the use of autologous, structural cartilage grafts in primary and secondary rhinoplasty. Emphasis is placed on the use of septal, auricular, and costal cartilage grafts to provide for a structurally sound skeletal framework and thereby a predictable postoperative result. Deformities of the middle and lower third of the nose are specifically addressed.