Modified Turkish delight: morcellized polyethylene dorsal graft for rhinoplasty

Richardson, Sunil; Agni, Nisheet; Pasha, Zameer

doi:10.1016/j.ijom.2011.03.013

Cited by 20 publications

(12 citation statements)

References 10 publications

(11 reference statements)

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“…Previous attempts to improve tissue integration of biomaterials included coating of implants with autologous material, such as chondrocytes [ 10 , 49 ], adipocytes [ 50 ], adipose tissue derived microvascular fragments [ 51 ], or acellular dermis [ 52 ] as well as with specific growth factors, e. g. basic fibroblast growth factor [bFGF; [ 53 – 55 ]] or vascular endothelial growth factor [VEGF; [ 34 ]]. Less specific, but already in clinical use, PPE coated with oxidized cellulose polymers and the patient’s blood (which contains uPA, tPA, and PAI-1) is successfully employed in reconstructive nose surgery [ 56 , 57 ]. Together with our actual findings on the role of the plasminogen activation system for the engraftment of PPE implants, we consequently hypothesized that surface coating with recombinant uPA, tPA, or PAI-1 supports the tissue integration of this biomaterial.…”

Section: Discussionmentioning

confidence: 99%

Components of the Plasminogen Activation System Promote Engraftment of Porous Polyethylene Biomaterial via Common and Distinct Effects

et al. 2015

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Rapid fibrovascularization is a prerequisite for successful biomaterial engraftment. In addition to their well-known roles in fibrinolysis, urokinase-type plasminogen activator (uPA) and tissue plasminogen activator (tPA) or their inhibitor plasminogen activator inhibitor-1 (PAI-1) have recently been implicated as individual mediators in non-fibrinolytic processes, including cell adhesion, migration, and proliferation. Since these events are critical for fibrovascularization of biomaterial, we hypothesized that the components of the plasminogen activation system contribute to biomaterial engraftment. Employing in vivo and ex vivo microscopy techniques, vessel and collagen network formation within porous polyethylene (PPE) implants engrafted into dorsal skinfold chambers were found to be significantly impaired in uPA-, tPA-, or PAI-1-deficient mice. Consequently, the force required for mechanical disintegration of the implants out of the host tissue was significantly lower in the mutant mice than in wild-type controls. Conversely, surface coating with recombinant uPA, tPA, non-catalytic uPA, or PAI-1, but not with non-catalytic tPA, accelerated implant vascularization in wild-type mice. Thus, uPA, tPA, and PAI-1 contribute to the fibrovascularization of PPE implants through common and distinct effects. As clinical perspective, surface coating with recombinant uPA, tPA, or PAI-1 might provide a novel strategy for accelerating the vascularization of this biomaterial.

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Section: Discussionmentioning

confidence: 99%

Components of the Plasminogen Activation System Promote Engraftment of Porous Polyethylene Biomaterial via Common and Distinct Effects

et al. 2015

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“…Donor-site morbidity in the temporal region remains the major drawback of retrieving a fascial graft to obtain a suitable nasal contour and/or to correct deficiencies of the nasal dorsum exceeding 2 mm; thus, fascial grafts should only be harvested in those patients with a thin skin [5]. Richardson et al [7] replaced the cartilaginous graft material with finely diced Medpor® (expanded polyethylene; Porex Surgical Inc., Newnan, USA) mixed with 1–2 cm 3 of the patient’s blood, whereas Bullocks et al tried to stabilize the graft structure by the addition of platelet-rich plasma and platelet-poor plasma instead of wrapping [8]. Although this method was time-consuming, significantly less resorption was observed by minimizing the degree of inflammation and permitting better revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…In 2000, Erol was the first to describe the use of diced cartilage that was wrapped in a monolayer of oxidized cellulose (Surgicel®, Ethicon, Somerville, USA), termed the Turkish Delight technique [2–4]. Many modifications of this technique have been made in an attempt to improve long-term results and extend its applicability to more complicated cases [5, 7–9]. The aim of this study was to present the modified Turkish Delight method using Surgicel®-wrapped hydroxyapatite granules and compare its use with other techniques.…”

Section: Introductionmentioning

confidence: 99%

The hydroxyapatite Turkish Delight: a technical note

Kustermans

Mommaerts

2017

Oral Maxillofac Surg

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Nasal dorsum augmentation is commonly performed using autologous cartilage grafts, also in the Turkish Delight technique. The aim of this study was to describe a modification of the Turkish Delight technique for dorsal augmentation consisting of small hydroxyapatite-calcium carbonate granules (0.5–1 mm) that were wrapped in layers of oxidized cellulose and glued with 1–2-cm3 fibrin sealant and to compare its utility with that of other techniques. Clinically stable and satisfactory results were achieved in the four cases examined. Cone-beam computerized tomography (CBCT) imaging revealed that there was no degradation of the graft up to 2 years after surgery. The use of a modified Turkish Delight method using hydroxyapatite granules promises to be a valuable option for the correction of nasal dorsum deficiency.

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“…Furthermore, autologous cartilage whether carved or crushed can undergo occasional displacement, resorption, has the tendency to warp and can also develop sharp edges over time which can increase the perceptibility of the graft. [1][2][3] Block bone grafts, on the other hand can undergo distortion, have the tendency to become visible with time and can also undergo occasional displacement and resorption. 1,2 These problems were addressed by Erol, who first advocated the use of finely diced autologous cartilage wrapped in a monolayer of Surgicel (oxidized cellulose) and termed it Turkish delight.…”

mentioning

confidence: 99%

“…[1][2][3] Block bone grafts, on the other hand can undergo distortion, have the tendency to become visible with time and can also undergo occasional displacement and resorption. 1,2 These problems were addressed by Erol, who first advocated the use of finely diced autologous cartilage wrapped in a monolayer of Surgicel (oxidized cellulose) and termed it Turkish delight. 2 Over the years, surgeons across the world have modified this existing technique with an attempt to improve the long-term results and to extend its applicability to more sophisticated cases.…”

mentioning

confidence: 99%

The Silicone Turkish Delight for Dorsal Augmentation in Rhinoplasty

Richardson

Khandeparker

Dhara

et al. 2021

Journal of Craniofacial Surgery

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Rhinoplasties are the most challenging facial aesthetic procedures with the majority of the cases requiring dorsal augmentation either in the form of autogenous or alloplastic materials. Although autogenous grafts are the gold standard, these grafts have their innate issues such as donor site morbidity, occasional displacement, resorption, tendency to warp or develop sharp edges over time with increased perceptibility and clinical visibility of the graft with time. These issues were addressed by Erol in 2000 who advocated the use of finely diced autologous cartilage wrapped in a monolayer of surgical and termed it Turkish delight. This technique has been extensively modified by surgeons across the world with an attempt to forgo the use of autogenous grafts preventing donor site morbidity and replacing it with alloplastic materials. Silicon's inert nature, resorption resistance, absence of a secondary surgical site and economical value make it a widely utilized allograft augmentation option in Asian countries. The authors hereby present a modification of the original Turkish delight technique by utilizing diced silicone pieces amalgamated with 1 to 2 ml of autologous blood and wrapped in monolayer of surgicel (oxidized cellulose). The technique produced clinically stable results in 27 patients who were followed up for a period of 24 to 60 months (average 30 months). Improved pliability, negated risk of graft extrusion with no donor site morbidity are the key advantages of this technique over conventional autologous grafts and silicon block augmentation techniques. These results point towards the viability of the technique for performing dorsal augmentation in rhinoplasty.

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Modified Turkish delight: morcellized polyethylene dorsal graft for rhinoplasty

Cited by 20 publications

References 10 publications

Components of the Plasminogen Activation System Promote Engraftment of Porous Polyethylene Biomaterial via Common and Distinct Effects

Components of the Plasminogen Activation System Promote Engraftment of Porous Polyethylene Biomaterial via Common and Distinct Effects

The hydroxyapatite Turkish Delight: a technical note

The Silicone Turkish Delight for Dorsal Augmentation in Rhinoplasty

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