Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis.

BACKGROUND: Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. METHODS: A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups. RESULTS: In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT. CONCLUSION: Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Two-Step Reconstruction of Non-Marginal Auricular Defects.

PURPOSE: Auricular reconstruction is an extensively discussed topic in facial reconstructive surgery and poses an immense challenge to the reconstructive surgeon. This report describes a 2-stage technique to repair non-marginal full-thickness defects of the auricle. MATERIALS AND METHODS: Thirteen patients underwent surgery after partial to complete loss of the auricular concha using an improved and refined method. Tissue from the pre- and retroauricular regions was used to replace nonhelical auricular tissue loss in 2 surgical steps. All procedures were performed in an ambulatory setting using local anesthesia. RESULTS: All 13 patients (age range, 37 to 82 yr; mean age, 68 yr; 4 women and 9 men) had excellent esthetic outcomes with low surgical morbidity and were satisfied with the achieved results. No flap necrosis was observed. Auricular vertical and horizontal dimensions changed minimally (0 to 4 mm). A tension-free closure of the donor-site defects could be achieved primarily. CONCLUSION: The present method uses 2 separate donor sites to reconstruct centrally located full-thickness defects of the auricle. It is straightforward to perform, minimizes the surgical steps required, shows excellent outcomes, and allows easier closure of the donor site because of the distribution of the harvested tissue.