Total Nasal Reconstruction Using a Prelaminated Free Radial Forearm Flap and Porous Polyethylene Implants

Tsiliboti, Dimitra; Antonopoulos, D; Spyropoulos, Konstantinos; Naxakis, S; Goumas, Panos

doi:10.1055/s-0028-1082893

Cited by 17 publications

(7 citation statements)

References 13 publications

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“…The use of various alloplastic materials for nasal framework reconstruction has been previously described, including titanium, Vitallium (Luhr), and porous polyethelene. 16,17 Titanium mesh, in particular, has been used in several prior studies, generally when covered with a vascularized internal lining. 15,[18][19][20][21][22] Most authors describe internal coverage of titanium mesh with cutaneous or mucosal flaps.…”

Section: Discussionmentioning

confidence: 99%

Titanium Mesh Nasal Repair without Nasal Lining

et al. 2017

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The objective of this study was to describe outcomes for patients who underwent titanium mesh reconstruction of full-thickness nasal defects without internal lining repair. This is a retrospective cohort study. Patients with through-and-through nasal defects were identified at a single academic institution between 2008 and 2016. Nasal reconstruction was performed with either titanium mesh and external skin reconstruction without repair of the intranasal lining or traditional three-layer closure. Five patients underwent titanium mesh reconstruction and 11 underwent traditional three-layer repair. Median follow-up was 11 months (range, 2-66 months). The only significant difference between groups was older age in patients undergoing titanium reconstruction (mean, 81 vs. 63 years; difference of 18; 95% confidence interval [CI], 4-32 years). Defect extent including overall size and structures removed was similar between groups ( > 0.05). Paramedian forehead flap was the most common external reconstruction in both groups (100% for titanium mesh and 73% for three-layer closure). Time under anesthesia was significantly shorter for titanium mesh reconstruction (median, 119 vs. 314 minutes; difference of 195; 95% CI, 45-237). Estimated blood loss and length of hospital stay were similar between groups ( > 0.05). Complication rates were substantial although not significantly different, 40 and 36% in titanium and three-layer reconstruction, respectively ( > 0.05). All patients with complications after titanium reconstruction had prior or postoperative radiotherapy. Titanium mesh reconstruction of through-and-through nasal defects can successfully be performed without reconstruction of the intranasal lining, significantly decreasing operative times. This reconstructive technique may not be suitable for patients who undergo radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Titanium Mesh Nasal Repair without Nasal Lining

et al. 2017

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“…The PPE is biocompatible, thus minimizing encapsulation but several complications have been reported (eg, infection, migration, fistula). 39 Thanks to these characteristics, other types of biomaterials, such as the polyetheretherketone, have been successfully used in complex maxillofacial reconstruction along with the RFF. 40 Prelamination of the RFF with a nonvascularized bone graft is another modification.…”

Section: Rff Prelaminationmentioning

confidence: 99%

Microsurgical Techniques and Postoperative Outcomes After Total and Subtotal Nasal Reconstruction

et al. 2021

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BackgroundMultiple microsurgical techniques for nasal reconstruction have been described in the literature. Given the gaps in the literature regarding evidence-based reviews for total and subtotal nasal reconstruction using microsurgical techniques, the purpose of this study was to provide a thorough presentation of the most popular microvascular techniques and their outcomes (functional and aesthetic) for total or subtotal nasal defects.MethodsA systematic search was performed using PubMed, Google Scholar, and Cochrane Library on free flap techniques for restoration of nasectomy defects. The keywords were “nasal reconstruction,” “nose,” “nasectomy,” “rhinectomy,” and “microvascular.” Inclusion criteria for analysis in the study were the largest clinical case series published in English within the past 15 years with more than 8 patients.Studies were analyzed for patient demographics, etiology of nasal loss, surgical approaches to reconstruction, outcomes, and complications. The current study was registered at the International Prospective Register of Systematic Reviews and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.ResultsThe initial search yielded 302 results. Eleven articles with a total of 232 patients met the inclusion criteria. The radial (n = 85) and ulnar forearm flaps (n = 20), auricular helical rim (n = 87), and anterolateral thigh flap (n = 30) were the most commonly reported free flaps in nasal reconstruction. The main etiologic factors were malignancy and trauma. The most common complication was partial flap necrosis.ConclusionsThe auricular helical and radial forearm flaps represent the most used free flaps for total and/or subtotal nasal defects with satisfactory patient outcomes.

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“…1 In addition, the good thermoplasticity of pPE implants allows their convenient adaption to patientspecific anatomic conditions. 17 However, despite all these advantages, most plastic surgeons still prefer autologous tissue for defect reconstruction because of the risk of pPE-associated complications, 18 including infection, [19][20][21] migration, [22][23][24] and extrusion [25][26][27][28] of the implant material. The occurrence of such unwanted complications is caused by an insufficient early vascularization and incorporation of pPE.…”

Section: Introductionmentioning

confidence: 99%

Vascularization Strategies for Porous Polyethylene Implants

Später

Menger

Laschke

2021

Tissue Engineering Part B: Reviews

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Porous polyethylene (pPE) is a frequently implanted biomaterial in craniofacial reconstructive surgery. Its rapid vascularization and tissue incorporation are major prerequisites to prevent complications, such as material infection, migration, and extrusion. To achieve this, several sophisticated strategies have been introduced and evaluated during the last 20 years. These include (i) the angiogenic stimulation of the host tissue with epidermal growth factor, basic fibroblast growth factor or macrophage-activating lipopeptide-2, (ii) material modifications, such as increase of surface roughness and incorporation of bioactive glass particles, (iii) surface coatings with growth factors, glycoproteins, acrylic acid, arginine/glycine/aspartic acid peptide as well as components of the plasminogen activation system and autologous clotted blood or serum, and (iv) the seeding with fibroblasts, chondrocytes, stem cells, or adipose-tissue-derived microvascular fragments. The majority of these approaches showed promising results in experimental studies and, thus, may be capable of improving the success rates after pPE implantation in future clinical practice.

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Total Nasal Reconstruction Using a Prelaminated Free Radial Forearm Flap and Porous Polyethylene Implants

Cited by 17 publications

References 13 publications

Titanium Mesh Nasal Repair without Nasal Lining

Titanium Mesh Nasal Repair without Nasal Lining

Microsurgical Techniques and Postoperative Outcomes After Total and Subtotal Nasal Reconstruction

Vascularization Strategies for Porous Polyethylene Implants

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