目的:囊状挛缩是一种罕见但严重的有机硅植入隆鼻手术并发症。严重时,挛缩会影响鼻子的所有层面,造成严重的疤痕和毁容。目前尚无评估鼻子收缩的标准化方法,也缺乏关于严重挛缩症治疗的文献。因此,本研究旨在建立硅胶隆鼻术后继发鼻挛缩的综合分级体系和治疗方法。
方法:我们对2012年至2021年出现鼻挛缩的患者进行了回顾性分析。所有术前照片均由两名整形外科医生进行评估,间隔一个月两次。拟议的评分系统包括:正常(一级),轻度挛缩伴可检测植入物(II级),中度挛缩伴皮肤变薄(III级),重度挛缩伴短鼻畸形(IV级),和背侧皮肤瘢痕的破坏性挛缩(Va级),或小柱缺乏症(Vb级)。使用kappa值来评估观察者之间和内部的一致性,以确定系统的可靠性。
结果:根据87例患者,对于两个评估时间点,观察者之间的一致是实质性的(k=0.701和0.723).观察者内部的一致性对于评估者1(k=0.822)是极好的,对于评估者2(k=0.699)是实质性的。
结论:使用此评分系统,我们提出了一种针对鼻子收缩的分级治疗算法。最值得注意的是我们在Vb级患者中使用radial前臂游离或前额皮瓣重建小柱。通过结合重建和美学原则,这种治疗方法为严重鼻子收缩的管理提供了有效和优雅的解决方案。
方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
OBJECTIVE: Capsular contracture is a rare but serious complication of silicone implant-based augmentation rhinoplasty. When severe, the contracture can affect all layers of the nose, causing significant scarring and disfigurement. There is currently no standardized method of evaluating contracted noses and a paucity of literature on the treatment of severe contracture. Therefore, this study aimed to establish a comprehensive grading system and treatment approach for patients with nasal contracture secondary to silicone implant-based rhinoplasty.
METHODS: We conducted a retrospective analysis on patients who presented with nasal contracture from 2012 to 2021. All preoperative photographs were evaluated by two plastic surgeons, twice at 1-month intervals. The proposed grading system comprised: normal (grade I), mild contracture with detectable implant (grade II), moderate contracture with skin thinning (grade III), severe contracture with short nose deformity (grade IV), and destructive contracture with scarring of the dorsal skin (grade Va), or columella deficiency (grade Vb). Inter- and intraobserver agreement was assessed using the kappa value to determine the reliability of the system.
RESULTS: Based on 87 patients, interobserver agreement was substantial for both evaluation time points (k = 0.701 and 0.723). Intraobserver agreement was excellent for evaluator 1 (k = 0.822) and substantial for evaluator 2 (k = 0.699).
CONCLUSIONS: Using this grading system, we propose a graduated treatment algorithm for contracted noses. Most notable is our use of radial forearm free or forehead flaps to reconstruct the columella in grade Vb patients. By combining reconstructive and aesthetic principles, this treatment approach provides an effective and elegant solution for the management of the severely contracted nose.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .