Costal cartilage graft with perichondrium, a possible anti-adhesive material

Modified Buried Vertical Mattress Suture Versus Buried Intradermal Suture: A Prospective Split-Scar Study

BACKGROUND

The modified buried vertical mattress suture (MBVMS) is believed to provide excellent outcomes by relieving the tension on wound edges. However, clinical data on the topic remain sparse and inadequate.

OBJECTIVE

To compare the cosmetic results of the MBVMS and the buried intradermal suture (BIS) in chest wounds using a split-scar model.

MATERIALS AND METHODS

Twenty patients participated in the study. One randomly selected half of each chest wound was closed with the MBVMS; the other half was closed with the BIS. Immediately, postoperatively, the maximum degree of wound eversion was obtained. After 3 months, the wound complication rates were recorded, and the aesthetic appearance of each scar was evaluated by the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), the visual analog scale (VAS), and scar width.

RESULTS

The MBVMS yielded a greater mean postoperative eversion height and width (p < .05); lower POSAS, VSS, and VAS scores (p < .05); and a narrower scar width (p < .05) than did the BIS.

CONCLUSION

Compared with the BIS, the MBVMS provided significantly increased wound eversion immediately, postoperatively, and improved aesthetic outcomes at the end of the 3-month follow-up period.

[Application of thin-ribbed cartilage with the perichondrium in correction of secondary cleft lip nasal deformity as lateral crural onlay graft]

Objective

To explore the application and effectiveness of thin-ribbed cartilage with the perichondrium in the correction of secondary cleft lip nasal deformity as the lateral crural onlay graft.

Methods

A retrospective study was performed based on the data of 28 patients with secondary nasal deformity of cleft lip between October 2015 and April 2017. There were 16 males and 12 females with an average age of 24 years (range, 18-31 years). There were 11 cases with secondary nasal deformities on the left side, 13 cases on the right side, and 4 cases on both sides. Three-dimensional stereotaxy of the nasolabial muscles was used to correct the deformity. The costal cartilage as the support was used to perform nasal columella and nasal dorsum while the thin-ribbed cartilage with the perichondrium was used as wing cartilage support. The photography of nasal position was taken before operation and at 6-8 months after operation. The midpoint of the junction between the nasal columella and the upper lip was marked point O; the lateral horizontal line passing through the point O was marked as X-line, and the longitudinal line (the midline) as Y-line. The distance of the highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, the symmetries of both the most lateral and the highest point of the bilateral nostrils, and the distance of the highest point of the nasal tip to the X-line were measured.

Results

All incisions healed by first intention. All patients were followed up 6 to 24 months with an average of 12 months. The size and shape of the noses were stable, and no compli cation, such as cartilage exposure, hematoma, or infection occurred during the postoperative follow-up. There were 4 cases with obvious incision scars, 3 cases with nostril and alar asymmetry, and 1 case of lateral side of the nose without well positioned. The symmetry of the highest points of bilateral nostrils was 57.643%±27.491% before operation and 90.246%±18.769% after operation. The symmetry of the most lateral points of the bilateral nostrils was 77.391%±30.628% before operation and 92.373%±21.662% after operation. And there were significant differences between pre- and post-operation ( P<0.05). There were also significant differences in the distance of highest point of the affected nostril to the X-line, the distance of the nostril's outermost point to the Y-line, and the distance of the highest point of the nasal tip to the X-line ( P<0.05). No thoracic contour change occurred at the costal cartilage donor site.

Conclusion

The thin-ribbed cartilage with the perichondrium has good support and long-term stability, and it can be used as one of the ideal materials for nasal alar cartilage transplantation for nasal deformity secondary to cleft lip.