BACKGROUND. In present days, there are described many reconstruction techniques for nasal post-traumatic and post-excision total defects, from simple suture to microsurgical free transfer in nasal reconstruction. It is important to follow the defect dimensions, its topography and also its etiology. The nasal aesthetic subunits principle is very important in aesthetic and functional reconstruction of a nasal defect.
MATERIAL AND METHODS. The clinical study from this paper was realised on the patients admitted in the Department of Plastic and Reconstructive Surgery of the Emergency Clinical Hospital from Bucharest, between 2012 and 2013. Different determinant factors were studied for the success of nasal reconstruction. It was compared the difference between the reconstruction of the whole nasal subunit, based on aesthetic subunits principle, and the reconstruction of the defect.
RESULTS. Although in our clinic the reconstruction of the defect is used in the majority of the cases and rarely the reconstruction based on aesthetic subunits principle, very good results were obtained, with a reduced number of complication and very few relapses.
CONCLUSION. The success of the reconstruction depends on multiple factors regarding the type of the defect. The grafts can give very good results in all aesthetic subunits, while the nasogenian flap has good results for the reconstruction of the nasal wing and lobule defects. The frontal flap is the first option for reconstruction of the dorsum nasi with satisfactory results. This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/137390
Andreea Grosu-Bularda, Claudiu Manea and Ioan Lascar
Olfactory ensheathing cells (OECs) join olfactory axons in their entrance to the central nervous system, representing a unique population of glial cells with functions in olfactory neurogenesis, axonal growth and olfactory bulb formation. Olfactory ensheathing cells have a great potential to induce repair for neural injuries, in central nervous system and peripheral nervous system, existing numerous experimental and clinical studies lately, reporting beneficial effects in anatomical and functional recovery. Studies are also conducted in order to establish possible pro-regenerative effects of the OECs, their potential in tissue repair and ability to modulate the immune system. The aim of this paper was to review the properties of olfactory ensheathing cells and their potential therapeutic role in regenerative medicine.
BACKGROUND. The reconstructive surgery is a domain in continuous research for new techniques and alloplastic materials for replacement of complex defects. Different biomaterials are used in soft tissue reconstruction including polypropylene meshes covered with collagen, which have the best results in abdominal and pelvic surgery, but are not yet used in nasal surgery.
MATERIAL AND METHODS. We analysed the studies from the literature regarding the different alloplastic implants used in nasal reconstruction surgery, their benefits and contraindications for nasal defects.
RESULTS. The most used polymers are Silicone, Medpor®, Mersilene® and polypropylene. Silicone is no longer widely used in facial reconstructive surgery because of its many complications. Medpor® (high-density polyethylene) is used for reconstruction of the facial skeleton and for aesthetic contour enhancement, including nasal reconstruction. Mersilene® (polyethylene terephthalate) is used for dorsum nasal defect reconstruction. Gore-Tex® is used for soft-tissue augmentation in the nose and is not recommended as a structural graft. Polypropylene meshes (Marlex®) are widely used in abdominal and chest wall reconstructive surgeries, with few studies on using them in nasal cartilage reconstruction.
CONCLUSION. Nasal reconstructive surgery is a difficult part of plastic surgery than can cause many problems to the surgeon, the need for soft tissue and cartilage reconstruction are difficult to solve in a repeatedly operated nose with few autogenous graft options and complex reconstructive surgeries, especially in posttraumatic defects and revision rhinoplasties. There are many alloplastic implants that can be used with excellent results.
Andreea Grosu-Bularda, Claudiu Manea, Luana Lazarescu and Ioan Lascar
Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties in remodelling a tridimensional structure. Reconstructive requirements are: correct deformity evaluation, selecting the most suitable treatment option, respecting the principle of aesthetic subunit, appropriate reconstruction of each affected nasal layer, long-term stabile functional and aesthetic results. Reconstructive procedures range from simple to very complex. Conventional techniques can fail in restoring a satisfactory appearance in severely disfigured patients, for whom a new possibility arises: Vascularized Composite Allografts (VCA) transplantation.
In this paper, we focus on nasal skeletal framework restoration. Structural defects may require a large amount of reconstructive material obtained usually from cartilage or bone autografts. Autologous cartilage is the gold standard in nasal architectural recovery, but in some cases, autologous graft sources are not available, imposing the necessity to use alternative solutions represented by the allografts or alloplastic materials. We analysed the specific features of skeletal allografts used in nasal reconstruction.
With current clinical experience, the use of cartilage and bone allografts (especially irradiated cartilage homografts) shows a promising reconstructive option for nasal structural defects. For extensive facial defects, including midface deformities, impossible to restore with traditional surgical techniques, a new reconstructive era was open through the development of the VCA field.