[Edema and hematoma prophylaxis in rhinoplasties. Clinical experiences with streptokinase].
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The authors report on the experience in 27 patients with noses damaged by radiation. Different types of local flaps from the forehead and distant flaps from the neck and arm for reconstruction are described.
Hypotension, induced by NNP during simultaneous artificial respiration in intubated patients, has proved its usefulness, especially in plastic surgery of the nose and nasal septum. NNP has shown to be a hypotensive medicament, which is easy to control and in which no secondary effects have been demonstrated. The controlled hypotension with NNP requests an experienced anaesthesist and a careful examination and supervision of the patient.
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A new technique of infracturing the lateral wall, using a "chisel forceps," allows precise infracturing without tearing of the periosteal attachments in the nasion region. This technique has so far also prevented double fracturing of the lateral walls so difficult to treat in the past.
Loss of the nasal tip has a more disastrous effect on the face than the size of the deformity would suggest, thus reconstruction becomes vital. Immediate replacement of the severed piece is first choice. If this is not possible and the defect is no more than 1.25 cm at its thickest depth, an auricular chondrocutaneous graft is next choice. When the tip defect is more extensive, a midline vertical forehead flap or, in rare cases, an arm flap is indicated.
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