Kyle A. Belek

Grafting the alar rim: application as anatomical graft.

Background: Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus. Methods: Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura. Surgical technique included the following: (1) an open approach was used; (2) a marginal incision that ignored the caudal margin of the lateral crus (the incision went straight posteriorly to a point 5 to 6 mm from the rim margin) was used; (3) a triangular graft was made to cover the exposed vestibular skin; (4) it was secured end to end to the caudal border of the lateral crus; and (5) the poster end was allowed to sit in a small subcutaneous pocket. Results: Follow-up was 11 to 19 months. All 12 patients exhibited good rims as judged by a blinded panel. Rim retraction was not fully corrected in one patient, but no further treatment was required. One patient did require a secondary small rim graft for residual rim concavity. Conclusions: The concept of grafting the alar rim is strongly supported by the authors’ results. The modifications the authors applied by designing the graft to be anatomical in shape has been a technical help. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Beneficial Effects of Postrhinoplasty Taping

BACKGROUND Initial patient perceptions of rhinoplasty results are complicated by early postoperative edema, ecchymosis, and distortion. Anecdotal evidence suggests that taping the nose immediately upon splint removal aids with the patients psychological adjustment to his or her new appearance. OBJECTIVES The authors attempt to assess the overall impact of taping after splint removal on patient well-being while providing statistical validation regarding the utility of this intervention. METHODS The authors evaluated the reaction of 24 postoperative rhinoplasty patients on the day of splint removal by photographing them and noting their verbal responses. Those patients who were obviously happy received no taping and were dismissed from the study. The remainder of the patients received flesh-colored tape (3M, St Paul, Minnesota) and their subsequent reactions were noted and photographed. RESULTS Of 24 consecutive patients, 16 received tape. Fifteen of those taped initially displayed a flat affect (group A), while 1 was clearly unhappy (group B). The remaining 8 patients were obviously happy (group C) and were excluded from taping. Thirteen (86%) of those in group A displayed immediate subjective improvement after taping (χ(2) = 12.8; P < .001). The lone patient in group B continued to be unhappy and required ongoing reassurance. CONCLUSIONS Application of tape immediately upon splint removal after rhinoplasty improves initial patient perceptions. Taping can provide a simple and risk-free intervention for patients who do not express immediate satisfaction.

Commentary on: A Complete Subperichondrial Dissection With Management of the Nasal Ligaments

The authors describe a new rhinoplasty operation that is entirely subperichondrial and preserves both Pitanguy’s ligament and the scroll ligament. They believe that dissection in the subperichondrial plane is less traumatic than in the sub-superficial musculoaponeurotic system (sub-SMAS) or subcutaneous plane and that restoring the integrity of the ligaments minimizes the potential for a supratip problem and helps restore valvular function. In 228 cases, they had only a 5% revision rate. What is exciting about the subperichondrial approach is that it is theoretically the best plane for dissection. Since the subperichondrial approach is best for the septum, why should it not be best for the rest of the nose? Moreover, restoration of normal anatomy (repairing the ligaments) is one of the most fundamental tenets of surgery. The authors extend the known anatomy of the nose established by Daniel1,2 one step further and make us aware of the importance of the scroll ligament for valvular function, which has never been emphasized this much before.3,4 The authors also make us aware of the importance of Pitanguy’s ligament. Finally, we are impressed that they are able to perform this type of delicate surgery. We do believe that most surgeons use a subperichondrial approach on the tip cartilages as they open the nose. However, as the upper lateral cartilages (ULC) are reached, the dissection becomes supraperichondrial because it has generally been considered too much effort to follow the perichondrium into the interstices of the scroll and get under the perichondrium of the ULC. We found that the authors are correct in that the …

145B: TOPICAL HOXA5 AND STABILIZATION OF VASCULAR LESIONS

Results: In vitro, B16-F10 melanoma cells showed decreased adhesion to and transmigration through endothelium treated with recombinant human aPC (rhaPC). In murine B16-F10 metastasis models, transgenic EPCR overexpressing (Tie2EPCR) mice exhibited marked reductions in liver (50%) and lung (92%) metastases compared to wildtype (WT) animals. Intravital imaging revealed reduced B16-F10 entrapment within livers of Tie2-EPCR compared to WT mice. A similar reduction was observed in WT mice treated with rhaPC. Strikingly, rhaPC treatment resulted in a 44% reduction in lung metastases. This was associated with decreased lung P-selectin and TNF-a mRNA levels.