The Efficacy of Melilotus Extract in the Management of Postoperative Ecchymosis and Edema After Simultaneous Rhinoplasty and Blepharoplasty

BACKGROUND: Melilotus extract has been used as a folk medicine in inflammation-related therapy. This study was undertaken to determine the potential benefits of this herbal extract in treating postoperative ecchymosis and edema after simultaneous rhinoplasty and blepharoplasty. METHODS: Augmentation rhinoplasty and double-eyelid blepharoplasty were performed in one procedure by the same surgeon on 46 patients. RESULTS: Postoperative edema and ecchymosis were evaluated independently by two investigators checking the upper eyelid, lower eyelid, and paranasal area at postoperative days 1, 4, and 7. Our data showed that the patients receiving melilotus extract (n = 16) had lower scores not only in upper-eyelid and lower-eyelid ecchymosis, but also in paranasal ecchymosis at postoperative day 7 when compared with those in the control group. No significant difference in postoperative ecchymosis was detected in the group receiving dexamethasone treatment (n = 16) when compared with the control group (n = 14) at postoperative days 1, 4, and 7. The mean scores of upper-eyelid, lower-eyelid, and paranasal edema at postoperative days 1 and 4 were significantly lower in the group receiving dexamethasone treatment (n = 16) than that in the control group. Although the scores of eyelid edema reduction in the patients receiving melilotus extract showed no difference when compared with the control group, paranasal edema was reduced much more at postoperative days 4 and 7 when compared with the control group. CONCLUSION: We suggest the appropriate use of melilotus extract based on its beneficial effects on the postoperative results after simultaneous rhinoplasty and blepharoplasty.     

Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty

BACKGROUND:

Steroids have proven to be of some benefit in rhinoplasty edema and ecchymosis when administered at a high and repeated dose.

OBJECTIVE:

To evaluate the effects of single-dose, long-acting intramuscular steroids on postoperative edema and ecchymosis after closed rhinoplasty with osteotomies compared with placebo.

METHODS:

A randomized, double-blinded, placebo-controlled trial was performed. Fifty-four patients were randomly assigned to two groups: 28 received a single dose of long-acting dexamethasone (mean [± SD] dose 16±4 mg) immediately before anesthetic induction; the remaining 26 received an intramuscular injection of saline solution. The same surgeon performed all surgeries, with patients under general anesthesia. Acetaminophen was the only analgesic used to control postoperative pain. High-resolution digital photographs were taken on postoperative days 1, 3, 7 and 14. Scoring was performed separately for eyelid swelling and ecchymosis by an independent observer using a graded scale (0 to 5) for edema and a scoring system (0 to 13) for ecchymosis.

RESULTS:

No statistically significant differences in terms of age, sex or amount of bleeding during surgery were found between the two groups. No statistically significant difference was observed in the decrease of both ecchymosis and edema between placebo and high-dose, long-acting dexamethasone. A statistically significant difference in operation time was found, favouring the steroid group. No severe complications were observed due to steroid use.

DISCUSSION:

Osteotomies are basically a form of (controlled) trauma, with considerable disruption of the abundant blood vessels in this facial region and, therefore, are associated with with undesirable effects. A recent meta-analysis failed to show benefits of the use of steroids after postoperative day 3. Only a trend toward reduction in edema and ecchymosis with the use of long-acting steroids compared with placebo was demonstrated in the present study.

CONCLUSION:

There was no benefit in administering single-dose, long-acting steroids in patients undergoing closed rhinoplasty with osteotomies.     

Running W Incision in Open Rhinoplasty: Better Scar Quality

Since 1997, 129 patients have undergone the open approach rhinoplasty procedure. Scar quality with running W incision was compared to the scar with V type incision. According to clinical and statistical evaluations after 6 months, postoperatively the running W incision group showed better scar quality than the V type incision group. The advantages of a running W incision are camouflaging the depressed scar in the incision line and decreasing the angles of the corners of incision lines. Running W type incision is superior to V incision on the columella and may provide less scaring than a single Z, and reverse V incisions according to our long-term clinical results.     

自体真皮瓣在隆鼻手术中的应用

目的 探讨自体真皮瓣游离移植结合多种材料在隆鼻手术中的应用。方法 2014年1月至2015年1月,根据患者鼻部的情况,对31例隆鼻患者采取自体真皮瓣结合硅胶假体、耳甲腔软骨综合隆鼻,并观察临床效果。结果本组患者术后真皮成活良好,鼻部外形自然、满意。随访6~12个月,除1例术后并发感染,经积极抗炎治疗有效,其余患者无并发症产生。结论 自体真皮瓣结合硅胶假体、耳甲腔软骨等综合隆鼻,可降低假体外露等并发症的发生率,术后鼻部外形自然,效果良好。     

高密度多孔聚乙烯植入体在鼻整形中的应用

目的 探讨高密度多孔聚乙烯在鼻整形中的应用.方法 2008年1月至2010年12月,分别将单片鼻小柱支架、双片鼻小柱支架和蝶形支架应用于33例鼻整形术患者.术后以6个指标评价手术效果,即鼻高度/鼻长度比例、ATC角、ACP角、鼻唇角、鼻额角和鼻尖角.结果 所有患者均获得满意疗效,除1例因鼻尖红肿而取出材料.女性患者中,术后鼻高度、鼻长度比例、ATC角度、鼻尖角、鼻唇角和鼻额角等指标有显著改善;男性患者显著改善的指标涉及鼻高度/鼻长度比例、ATC角度、鼻尖角和鼻额角等.结论 高密度多孔聚乙烯可提供足够的支撑力,是鼻整形的理想材料.     

Rhinoplasty and its psychological implications: Applied psychology observations in aesthetic surgery

Interest in the psychological problems that have always been associated with plastic surgery has been growing in the last 30 years, as moral and social prejudices have become less important. This interest has concentrated on the psychological mechanisms that induce patients to undergo surgery and on the selection criteria to be followed by surgeons. This report proposes a new method for tackling these problems. It is based on our experience as well as on the investigation, by means of interviews and tests (MMPI and Rorschach), of subjects requesting rhinoplasty.These elements have helped in propounding theories on the relationship between surgery and its psychological aspects, as based on three points: 1) the feelings of the individual that derive from the presence of an actual deformity or from the mere subjective feeling of one; 2) the nature and magnitude of the limitations on the patient's desire to get rid of the deformity; 3) the conflicts deriving from the contrast between subjective ideas of deformity and perfection and what can actually be achieved through surgery.Practical criteria for selection of patients are presented, including an analysis of the surgeon's emotional reactions during the first interview, which is regarded as a relationship already interpersonal and somewhat therapeutic. Anderson's questionnaire is discussed as an alternative possibility.     

Rhinometry: An Important Clinical Index for Evaluation of the Nose Before and After Rhinoplasty

Background Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty. Methods “Rhinometry” is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. Measurements of these parameters were performed for 300 patients before rhinoplasty and in the follow-up visits 3 months postoperatively. Results Preoperatively, the nasal length and tip projection for most patients were more than ideal. There was moderate reduction in nasal length (mean, 9.21 mm) and a decrease in tip projection (mean, 3.34 mm) for the majority of the patients after rhinoplasty. Reductions in nasal length, tip projection, bony base width, alar base width, and alar base width during a smile were statistically significant. Patients who underwent surgery using the closed approach had significantly more reduction in nasal length and less reduction in tip projection. All the patients were satisfied with these pre- and postoperative data. Rhinometry changed the ideas of the authors about some changes that their operative approaches produce. Conclusions Rhinometry can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.     

聚丙烯酰胺水凝胶注射隆鼻术后并发症的处理及临床分析

目的探讨聚丙烯酰胺水凝胶注射隆鼻术后并发症产生的原因及相关的处理。方法通过总结处理52例聚丙烯酰胺水凝胶注射隆鼻术后并发症的经验体会，分析并发症产生的原凶及处理补救措施。结果52例中产生的并发症有感染、肉芽肿、皮肤破溃、外形不良、疼痛和严重的心理压力等。每例有1～4种并发症。根据不同情况采取不同处理方法，并选取适当病例在取出聚丙烯酰胺水凝胶的同期或二期置入硅胶或膨体聚四氟乙烯假体，多数病例能取得较满意的效果，少数病例遗留后遗症和长久的心理压力或鼻部隐痛。结论聚丙烯酰胺水凝胶注射隆鼻术后并发症种类多样，与聚丙烯酰胺水凝胶的同有性质、鼻部软组织解剖特点有关。出现并发症后反复抽吸，会导致聚丙烯酰胺水凝胶分布更加紊乱，损伤加重。只有采取综合的手术方法才能较彻底地清除聚丙烯酰胺水凝皎。     

Corticosteroids and wound healing: clinical considerations in the perioperative period

Background

Determining whether systemic corticosteroids impair wound healing is a clinically relevant topic that has important management implications.

Methods

We reviewed literature on the effects of corticosteroids on wound healing from animal and human studies searching MEDLINE from 1949 to 2011.

Results

Some animal studies show a 30% reduction in wound tensile strength with perioperative corticosteroids at 15 to 40 mg/kg/day. The preponderance of human literature found that high-dose corticosteroid administration for <10 days has no clinically important effect on wound healing. In patients taking chronic corticosteroids for at least 30 days before surgery, their rates of wound complications may be increased 2 to 5 times compared with those not taking corticosteroids. Complication rates may vary depending on dose and duration of steroid use, comorbidities, and types of surgery.

Conclusions

Acute, high-dose systemic corticosteroid use likely has no clinically significant effect on wound healing, whereas chronic systemic steroids may impair wound healing in susceptible individuals.     

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。     

The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair

STUDY OBJECTIVE: To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam. DESIGN: Prospective, double-blind, randomized clinical investigation. SETTING: Operating room and postoperative recovery area. PATIENTS: 44 ASA physical status I and II adult male patients undergoing varicocelectomy. INTERVENTIONS: Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacaine. MEASUREMENTS: Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patients' global assessments also were recorded. MAIN RESULTS: Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001). CONCLUSION: Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively.     

透明质酸注射与硅胶假体在美容整形隆鼻手术中的应用效果

目的 探究在美容整形隆鼻手术中运用透明质酸注射与硅胶假体的效果差异性。方法 选取 2020年12月-2021年12月本院收治的80例开展美容整形隆鼻手术患者作为研究对象,采用随机数表法分为 对照组及试验组,各40例。对照组采用硅胶假体隆鼻,试验组采用透明质酸注射液隆鼻,比较两组隆鼻满 意度、鼻部形态学指标、术后1年隆鼻维持率、并发症发生率。结果 两组隆鼻满意度评分比较,差异无统 计学意义（P＞0.05）;两组术后15 d鼻长、鼻唇角、鼻尖角、鼻孔长轴角、鼻背长度、小柱-小叶比、鼻小 柱高度、鼻尖突出度指标比较,差异无统计学意义（P＞0.05）;两组隆鼻维持率比较,差异无统计学意义 （P＞0.05）;试验组并发症发生率低于对照组,差异有统计学意义（P＜0.05）。结论 在美容整形隆鼻手 术中,运用透明质酸注射与硅胶假体隆鼻,其效果与患者满意度无明显差异,但透明质酸注射隆鼻的并发 症相对较少,安全性更高。     

Rhinoplasty and Nasal Function in Patients with Cleft Lips

The purpose of this study was to find out whether harvesting septal grafts and simultaneously doing a septoplasty improves nasal function in patients with clefts who are having a rhinoplasty to correct the external deformity. We studied 14 patients with a unilateral cleft (UCL(P)) and four with bilateral clefts (BCLP). Nasal airflow resistance was measured with active rhinomanometry preoperatively and postoperatively. In nine of the 14 with UCL(P) and in all those with BCLP nasal resistance was normal or near normal both preoperatively and postoperatively. In five with UCL(P) postoperative nasal resistance was highly increased on the cleft side and in three of these patients nasal resistance decreased significantly but still remained abnormal. Only one patient subjectively complained of poor nasal airflow but all sought improvement of their nasal appearance. Harvesting of the graft and simultaneous straightening of the nasal septum during a rhinoplasty in patients with clefts neither improved, nor had a deleterious effect on, nasal function.     

Relationship between the protrusion of the nasal tip and the dorsum in Rhinoplasty

The author discuses the relationship of the nasal tip and its protrusion to the physical contours of the dorsum. This relationship can be positive or negative. He emphasizes the necessity of correcting the tip before any correction of the dorsum, believing that correction of the alar cartilages is the key that determines the amount of hump resection or of lowering of the nasal dorsum, demonstrating his concepts with appropriate case illustrations. The author's technique (1974) of forward projection of the lower nasal base with a transverse silicone implant for patients with a negative tip-dorsum relationship is described.     

应用软组织充填材料隆鼻术

目的探寻一种不仅外形美观逼真,手感也可以达到柔软自然效果的隆鼻材料和方法。方法应用膨体聚四氟乙烯和脱细胞真皮基质等软组织补片作为软组织充填材料进行隆鼻手术。结果本组158例患者,术后随访鼻外形均良好,手感自然,无免疫排斥反应、假体外露、假体活动等情况发生。结论膨体聚四氟乙烯（ePTFE）和脱细胞真皮基质（ADM）等软组织补片在隆鼻整形中操作方便,外形美观自然,手感可以以假乱真。手术不仅可以有效地增加鼻背的高度,而且也可以有效地延长鼻子的长度,抬高鼻尖。