tailieunhanh - Rhinoplasty Dissection Manual - part 9

Một duy nhất, tiêm dưới da 6-0 polydioxanone khâu (PDS) có thể được đặt trong các mô da để tăng cường cạnh eversion da và căng thẳng của việc đóng cửa (Hình I). Ture su nên cung cấp liên kết cạnh da và eversion nhẹ. Eversion quá mức sẽ cre ăn một biến dạng có thể đòi hỏi nhiều tháng để giải quyết. | 13 Incision Closure Nasal Splint Postoperative Considerations CLOSURE OF THE MIDCOLUMELLAR INCISION A single subcutaneous 6-0 polydiọxanone suture PDS can be positioned in the dermal tissues to enhance skin-edge eversion and take tension off of the closure Fig. 1 . This suture should provide skjn-edge alignment and slight eversion. Excessive eversion will create a deformity that may require many months to resolve. The level of the skin edges must be precisely aligned with this suture otherwise an unsightly scar may result. If there is no tension on die closure a subcutaneous suture may not be necessary. To close the skin five 7-0 nylon vertical mattress sutures are used. The first suture lines up the apex of the inverted V. The next two sutures are angled from medial on the lower flap to lateral on the upper flap to align the closure properly. A 6-0 chromic suture is used to line up the vestibular skin at the corner of the columellar flap. This comer suture is important because aberrant healing of this comer can result in a visible notch defect. 149 150 RHINOPLASTY DISSECTION MANUAL Incision Closure Nasal Splint Postoperative Considerations 151 Figure 1. A-D Closure of external columellar incision. Note how the two sutures placed just off the midline are angled from medial on the lower flap to lateral on the upper flap. This will recruit redundant skin medially and prevent lateral notching of the columellar incision. Intraoperative photographs E F highlight proper suture placement. When the columellar flap is elevated properly and then closed meticulously it should be inconspicuous as illustrated in this preoperative G and postoperative H base .