LAUSR

This study involves the use of concentrated growth hormone (CGH) to allegedly accelerate the healing of nasal defects post-rhinoplasty. Ten patients were in the study who were followed up for 3–6 months. The patients received dorsal augmentation with alloplastic material and some cartilage (costal or ear) for tip augmentation. Presumably, septal cartilage was not used. Patient progress was assessed at 7–14 days post-rhinoplasty. Wounds of various sizes were seen in the septum of these ten patients—mostly in the ‘anterior region,’ presumably where an entry incision was made for implant insertion. Wounds varied in size from 4 to 20 mm. If ‘conservative’ treatment (including antibiotics) failed, the author would use CGH. The patient’s blood was spun down, and the middle layer (rich in fibrin, platelets) was used to make both liquid and gel for subsequent treatment. After debriding the wound edges, the region surrounding it was injected with the liquid form and the gel was applied to the wound surface. This process would be repeated as many times as necessary until the wound is finally healed. All did heal although a few cases required implant removal. The one case example is given as an example but it was not representative in that the wound was infected with Pseudomonas. We can assume for the moment that there are wound healing benefits of concentrated factors such as platelets, fibrin, and hormones such as CGH. A few studies in plastic surgery indicate that that there are measurable improvements in wound healing by one or all of these factors [1–3]. However, the immediate question is whether or not that benefit can be convincingly demonstrated by this particular study. Even if the total number of cases performed in this series was a few hundred, ten cases of septal wounds would be a relatively high percentage in my experience. Septal wounds following rhinoplasty are uncommon these days in part because an open approach is used which allows much better visualization for dissection of the mucous membrane off the cartilaginous septum. In this study, there did not appear to be any actual septoplasty to harvest cartilage for the tip augmentation. We are also not told what incisions were made to insert the tip grafts. Therefore, the wounds were presumably in the area of the entry incisions. It is even more surprising that an entry incision should have wound healing difficulties and one has to wonder if a better location would have avoided the problem in the first place. For example, assuming one plans to use a closed approach to insert a dorsal graft, the intercartilaginous incision would be a good choice. If one is using a marginal incision to access the tip region, dissection can be continued to make a pocket in the dorsal region. There would appear to be no reason to involve the septum with its naturally thin tissues and vulnerable to poor healing. Hopefully, the septal tissues were hyperinfiltrated prior to making the pocket so that dissection can be facilitated with the least trauma to the tissues. Lastly, and most obviously, assuming one & Ronald P. Gruber [email protected]