Fixation of the Cartilaginous Vault with Barbed Suture in Closed-Approach High-Septal-Resection Dorsal Preservation Rhinoplasty.

Fixation of the cartilaginous vault is an important maneuver in preservation rhinoplasty to reduce hump recurrences. This paper presents a cartilaginous vault fixation technique with a barbed suture. Forty-six patients who underwent closed-approach high-septal-resection dorsal preservation rhinoplasty between August 2019 and March 2020 were included in this retrospective study. According to the cartilaginous vault fixation sutures applied, the patients were divided into two main groups as follows: (1) barbed suture and (2) conventional suture. Standardized postoperative 1-month lateral view photographs were scanned for the presence of any degree of hump recurrence. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 12 months. Hump recurrence was detected in one patient in the barbed suture group (n = 21) and one patient in the conventional suture group (n = 25; p > 0.05). For the ROE scores and number of satisfied patients, no statistically significant difference was found between the barbed and conventional suture fixation techniques (p > 0.05). Fixation with barbed suture showed similar results to conventional suture fixation. Barbed sutures can be used for cartilaginous vault fixation, taking advantage of the ease of placement in closed rhinoplasty. This study reflects level of evidence IV.

Capsular contracture around silicone miniimplants following bacterial contamination: an in vivo comparative experimental study between textured and polyurethane implants.

BACKGROUND: Capsular contracture remains a problem following breast implant surgery. Although impact of biofilm and implant surface on capsule formation has been demonstrated, interaction of microorganisms with different surface types has not been clarified yet. We aimed to compare the ability of biofilm formation of implants with different surfaces, under standard conditions and to demonstrate its impact on capsular contracture. METHODS: Twenty-four rats were divided into four groups. Mini-implants with three different surfaces (fine-textured, rough-textured and polyurethane) were placed on the dorsum of each rat. In Group-1, sterile implants were placed in submuscular pockets. In Group-2, implants were incubated in Staphylococcus epidermidis medium before implantation. In Group-3, before implantation, implants were immersed in Rifamycin solution following bacterial contamination. In Group-4, sterile implants were immersed in Rifamycin solution before implantation, and served as the control group. Rats were sacrificed at three months. Clinical, microbiological, histological and immunohistochemical evaluations were performed. RESULTS: Capsule contracture developed only on infected rough-textured implants. Rough-textured and polyurethane implants showed more biofilm formation than fine-textured implants. Capsule thickness and inflammatory cell density were higher on rough-textured implants compared to fine-textured implants (p = 0.004). Actin sequence was parallel and concentric on fine-textured and rough-textured implants; but was in irregular array on polyurethane implants. CONCLUSION: In presence of bacterial contamination, rough-textured implants have the most propensity of developing capsular contracture comparing to fine-textured and polyurethane implants at three months after implantation. Despite high bacterial load and biofilm formation, polyurethane implants are resistant to capsule contracture due to surface characteristics.

A Novel Stitching Technique: Adjustable Closed-Loop Sewing Machine Lock Stitching Technique to Bend or Unbend Cartilages.

This study aimed to evaluate the effect of a novel adjustable, closed-loop sewing machine lock stitching technique on cartilage shape. This study was performed on 18 rabbits that were divided into 3 groups to evaluate the short- (Group I), medium- (Group II), and long-term (Group III) effects of the technique on cartilage shape. Three cartilage grafts were obtained from the right and left ears of the rabbits and measured angularly. For the cartilage grafts obtained from the right ears, contours were corrected using the stitching technique proposed herein. The cartilage grafts obtained from the left ears were not stitched; these were maintained as the control group. Angular measurements were performed for the stitched cartilage grafts, and all the cartilages grafts obtained were finally embedded into the rabbits' backs. The rabbits in Groups I, II, and III were euthanized at week 2, 6, and 12, respectively, after which the cartilages were reevaluated for angular measurement and submitted for histopathological examination. A significant improvement from baseline was detected in the angular measurements of the stitched cartilage grafts obtained from the rabbits in each group. For the stitched cartilage grafts obtained from Group II and III rabbits, the angular measurements obtained immediately after stitching were found to be better than those obtained after euthanasia. In histopathological evaluation elevated collagen, perichondrium, and connective tissue levels were detected in grafts obtained from Group III rabbits. The novel stitching technique proposed herein appears to have beneficial long-term effects on the maintenance of cartilage contour.