Is polydioxanone foil an effective material for stabilizing septal segments in nasal septal reconstruction?
Background: Post surgical nasal septal integrity must be restored if a functionally and aesthetically healthy nose is desired. When autogenous cartilage for reconstruction is unavailable or procurement is excessively morbid, allografts are often considered. Resorbable polydioxanone foil may be useful in nasal septal reconstruction for stabilizing septal segments.
Study Design: Retrospective medical record review.
Setting: Single facial plastic surgeon practice in the department of otolaryngology and facial plastic surgery, Royal Surrey County Hospital in Guildford, England
Synopsis: Fifty patients were treated between April 2004 and February 2008 using polydioxanone foil. These cases involved septal reconstruction with or without rhinoplasty performed via endonasal or external rhinoplasty approaches. Median follow-up for the NPF and PF groups were 51.5 and 20.5 months, respectively. Forty-three of 50 patients were completely satisfied and without complications, whereas seven patients (7/26 NPF treated, 0/24 PF treated) required revision surgery. The results demonstrated increased negative outcomes with thicker, non-perforated foil (NPF) compared with thinner, perforated foil (PF). Complications included minor tip and collumella irregularity (2/7), septal granulation and swelling (1/7), and moderate dorsal saddling (4/7). All four patients experiencing saddling were treated with the unperforated thicker (0.25 mm thick) ZX5 foil. Patients treated with the thinner perforated (0.15 mm thick) perforated ZX7 foil did well with fewer complications. The patient who experienced the septal granuloma also was treated with the thicker unperforated ZX5 foil.
Although complications only occurred in those patients treated with NPF, the increased experience level and shorter follow-up in the PF group may limit what can be extrapolated from these results. The loss of septal cartilage support, however, is likely secondary to vascular compromise during prolonged isolation between the NPF. Therefore, conservative PF use is recommended for stabilizing the weakened septal L- strut when autogenous cartilage is unavailable. The thinner perforated ZX7 foil will allow vascular ingrowth and support of the cartilage.
Bottom Line: Perforated thinner ZX7 polydioxanone foil is an effective reconstructive material for providing temporary septal support when autogenous cartilage is unavailable. The resorbable foil can be used to splint cartilage segments until scarring can set the segments into position.
Citation: Tweedie DJ, Lo S, Rowe-Jones JM. Reconstruction of the nasal septum using perforated and unperforated polydioxanone foil. Arch Facial Plast Surg. 2010;12(2):106-113.
—Reviewed by Bo Brobst, MD, and Dean M. Toriumi, MD