Despite the improvement of primary repair of nasal deformities during the management of cleft lip in infancy, this does not exclude the need for revision rhinoplasty in adulthood for complete patients’ rehabilitation. The purpose of this study was to evaluate the aesthetic outcome of secondary rhinoplasty using costal cartilage grafts in patients with unilateral cleft lip nasal deformity. Twenty patients who were operated at earlier ages for correction of cleft lip and had a residual unilateral cleft lip nasal deformity were included in this study. Costal cartilage rib grafts were harvested; carved and used for maxillary augmentation, columellar strut graft, and lateral crural strut graft. Five anthropometric measurements (nostril height, width and gap area, columellar axis deviation angle and nasal base inclination angle) were used for evaluation of aesthetic results. The ratio of nostril width, height and gap area between the cleft side and the non-cleft side showed significant improvement (P <0.05). The columellar axis deviation showed significant improvement towards the midline (P = 0.004), and the alar base inclination showed improvement towards the horizontal line (P = 0.0045). In conclusion, the aesthetic outcomes of secondary cleft lip rhinoplasty using the costal cartilage are satisfactory. The costal cartilage has the required strength, is easily carved and maintains shape for considerable time.
Background: The aim of the study to present the reliability of application of intermingled skin homoograft and autograft in major deep burn cases in comparison with using homograft only. Early excision and skin graft closure of major burns is a life-saving procedure that reduces morbidity and mortality of severe burns. Patients suffering major burns lack adequate donor site skin graft to resurface burn wounds so they need another substitutes for coverage as homograft.Methods: This cohort prospective study was conducted at Menoufia University Hospitals from January 2017 to January 2019 and with follow up 6 months. The population of the study was 54 patients with major deep burns. After stabilization they were divided into 2 groups, the first underwent homograft and the second underwent combined homograft and autograft. They vary between children and adults. Follow up done over 6 months regarding rejection, need of another graft and mortalityResults: Our study was undergone on 54 patients; 30 patients homograft (55.5%) and 24 patients combined grafts (44.5%). Forty eight patients survived, and six patients died (12.5%), with a mean age 26.3 years (range, 1-50). There was statistically significant difference between 2 groups regarding rejection time, need of another graft, percentage of rejected area and mortality.Conclusions: Combined homografts and autografts is considered gold standard in management of major burns with lack of adequate autograft. It is superior to use of homograft only regarding morbidity, mortality and need for another graft.
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