Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose

Inchingolo, Francesco; Tatullo, Marco; Marrelli, Massimo; Inchingolo, Alessio Danilo; Corelli, Roberto; Inchingolo, Angelo Michele; Dipalma, Gianna; Abenavoli, Fabio Massimo

doi:10.1186/1746-160x-8-10

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…It is therefore not possible to determine if patients experienced less or more postoperative pain with this approach compared to other techniques. There were no cases of chondritis/ perichondritis, consistent with the literature reports of safe harvesting of cartilage and perichondrium from the concha [ 7 - 10 ].…”

Section: Discussionsupporting

confidence: 88%

Tympanoplasty—conchal cavum approach

Man

Nunez

2016

J of Otolaryngol - Head & Neck Surg

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ᅟThe three well recognized tympanoplasty approaches: permeatal, postaural, and endaural, each have advantages and disadvantages. The permeatal approach is suitable only for ears with adequate canal size. The postaural approach limits visualization of the posterior eardrum margin. The endaural approach limits the view of the eardrum's anterior margin.This study describes a modified endaural approach, developed to overcome these limitations. A retrospective case series review and collection of a prospective cohort of patient reported outcome data were undertaken to assess the technique.MethodStandard incisions as used in an endaural approach are placed within the ear canal. The novel incision extends from the superior canal incision into the conchal cavum. This allows a flap of the thick, hairbearing skin from both the bony and cartilaginous portions of the canal to be raised, and everted, to provide an excellent view of the entire drum. Perichondrium can be harvested for grafting from the conchal cavum.The clinical charts of all patients operated on by the first author using this technique from 2010–2012 were retrospectively reviewed. The size and position of the perforation, size of the canal, whether primary or revision surgery, graft take rate, hearing results and the occurrence of chondritis/perichondritis were recorded.To investigate the morbidities and the acceptance by the patients of the incision/scar in the conchal cavum, all patients undergoing the procedure in the 8 months up to the end of August 2013 were prospectively recruited to complete a self-assessment Likert scale questionnaire recording postoperative pain, and satisfaction with the cosmesis of the operative site. The clinician recorded if there was any evidence of chondritis/perichondritis.ResultsA 100 % graft take rate was achieved in the 75 adults treated by the first author from 2010 to 2012 regardless of the size and position of the perforation, configuration of the canal, primary or revision surgery.Preoperative Pure Tone Audiometric (PTA) Air Bone Gap (ABG) averaged over 3 frequencies (0.5, 1 and 2 K Hz) was 19.4dB (standard deviation = 9.6, range 2 to 50). Postoperative PTA ABG average was 6.2 dB (standard deviation = 8.3, range -7 to 37), demonstrating a statistically significant post-surgery mean improvement of 13.2 dB (paired T-test, p < 0.001).Twenty-one patients who underwent the procedure in 2013, reported minimal postoperative analgesic use, and scored the acceptability of the incision scar highly (4.8 out of a maximum of 5). There was no case of chondritis/perichondritis in the 96 cases.ConclusionWhilst it is the surgeon’s decision to use a permeatal, postaural or endaural approach, the endaural approach with the conchal cavum modification is an excellent alternative to the traditionally described approaches.Trial RegistrationClinical trial number: NCT02000843 at ClinicalTrials.gov

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Section: Discussionsupporting

confidence: 88%

Tympanoplasty—conchal cavum approach

Man

Nunez

2016

J of Otolaryngol - Head & Neck Surg

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“…The modern and sophisticated techniques of GBR involve the use of grafting materials in order to restore anatomy and physiology of the areas with bone decrement 26 .…”

Section: Discussionmentioning

confidence: 99%

Platelet Rich Fibrin (P.R.F.) in Reconstructive Surgery of Atrophied Maxillary Bones: Clinical and Histological Evaluations

Tatullo

Marrelli²,

Cassetta³

et al. 2012

Int. J. Med. Sci.

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132

136

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Introduction. Maxillary bone losses often require additional regenerative procedures: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF (Platelet Rich Fibrin) was tested for the first time in France by Dr. Choukroun.Aim of the present study is to investigate, clinically and histologically, the potential use of PRF, associated with deproteinized bovine bone (Bio-Oss), as grafting materials in pre-implantology sinus grafting of severe maxillary atrophy, in comparison with a control group, in which only deproteinized bovine bone (Bio-Oss) was used as reconstructive material.Materials and Methods. 60 patients were recruited using the cluster-sampling method; inclusion criteria were maxillary atrophy with residual ridge < 5mm. The major atrophies in selected patients involved sinus-lift, with a second-look reopening for the implant insertion phase. The used grafting materials were: a) Bio-Oss and b) amorphous and membranous PRF together with Bio-Oss. We performed all operations by means of piezosurgery in order to reduce trauma and to optimize the design of the operculum on the cortical bone. The reopening of the surgical area was scheduled at 3 different times.Results. 72 sinus lifts were performed with subsequent implants insertions.We want to underline how the histological results proved that the samples collected after 106 days (Early protocol) with the adding of PRF were constituted by lamellar bone tissue with an interposed stroma that appeared relaxed and richly vascularized.Conclusions. The use of PRF and piezosurgery reduced the healing time, compared to the 150 days described in literature, favoring optimal bone regeneration. At 106 days, it is already possible to achieve good primary stability of endosseous implants, though lacking of functional loading.

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“…To our knowledge, no study has reported satisfactory results for nasal reconstruction using a large postauricular composite graft (larger than 2.0 cm). Inchingolo et al 17 reported the use of a skin-perichondrium-cartilage graft to cover large nasal defects in a 74-year-old patient; however, the transplanted graft showed severe skin contraction, and there was disfiguration of the nasal dorsum. In these cases, the skin-fat-fascia composite grafts survived without dermal fibrosis or skin contraction, and the epidermal appendages were spared.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Distal Nasal Defects With a Large Postauricular Skin-Fat-Fascia Composite Graft

Liu

et al. 2021

Ann Plast Surg

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Background: Composite grafts have previously been reported to achieve a good outcome for nasal defect repair, but composite grafts have greater metabolic needs than simple skin. Therefore, the traditionally recommended size of a composite graft for nasal reconstruction is less than 1.5 cm in diameter. However, the distal nose is generally well supplied with blood vessels, which might support the use of larger composite grafts in such a highly vascularized recipient site. The aim of the article is to investigate whether a large skin-fat-fascia composite graft (larger than 2.0 cm) is viable for the repair of partial-thickness nasal defects. Methods: From October 2017 to December 2019, 13 patients with partial-thickness nasal defects underwent nasal reconstruction using a large postauricular skin-fat-fascia composite graft. Cases were followed up for 3 to 14 months postoperatively. The aesthetic outcome was evaluated in comparison with preoperative digital images. Results: Skin-fat-fascia composite grafts survived without graft necrosis, dermal fibrosis, or skin contraction in all cases. Favorable aesthetic outcomes were obtained in all patients, and no further revision surgery was need. Conclusions: A postauricular composite graft larger than 2.0 cm is a safe and effective reconstruction approach for partial-thickness nasal defects. This technique offers significant advantages in terms of no additional facial scar, no visible asymmetry on the face, no additional surgery for revision, and with mild scar in the donor site of the postauricular region.

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Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose

Cited by 8 publications

References 6 publications

Tympanoplasty—conchal cavum approach

Tympanoplasty—conchal cavum approach

Platelet Rich Fibrin (P.R.F.) in Reconstructive Surgery of Atrophied Maxillary Bones: Clinical and Histological Evaluations

Reconstruction of Distal Nasal Defects With a Large Postauricular Skin-Fat-Fascia Composite Graft

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