Use of PDS Plate and New 'tension Tile System' in Rhinoplasty: Our Experience.

Introduction

Complex rhinoplasties in patients with unstable crooked septum or limited graft availability have always been a challenge even for the master rhinoplasty surgeons. Previously available artificial materials have been associated with high exposure and infection rates. PDS(Polydiaxanone) being an absorbable material doesn't suffer from these disadvantages.^1,2 However it is not used as a graft substitute but as a graft support. We describe a new technique of using PDS plate with 'tension tiles' using the same pds plate bolsters to prevent sutures from cheese-wiring.

Material & Methods

Various ways we have used PDS plate it in complex rhinoplasties are

1. As a septal support to correct crooked septum both intra and extracorporeal methods.^3,4

2. As a support template for dorsal grafts especially when a single graft segment is unavailable. Multiple grafts, septal or auricular can be secured like a mosaic on to it and even be stacked.(figure 1)

3. As a septal extension graft between the septum and columellar graft to lengthen the nose.

4. Ingenious use of small PDS segments as tension tiles to prevent cut through of the suture when securing rib or septal cartilage grafts. This allows stable fixation with no danger of the sutures cheese wiring and makes this technique very reliable.(Figure 2 and 3)

Results

50 cases of Rhinoplasty were performed using PDS plate as a graft support for 35 females and 15 male patients.

Indications were varied and as mentioned above. 48 cases were open and 2 were closed rhinoplasties.

Follow up ranged from 6-12 months with an average of 7months.

On a visual analogue scale all patients rated their results as very good or excellent with no unsatisfactory result.

No plate exposure or infections were seen.

No cases of warping were seen in the cases where rib cartilage was used with the pds plate

Conclusion

PDS plate is a wonderful mate of the rhinoplasty surgeons. We describe an ingenious way of using it with the use of tension tiles made out of small pds plate bolsters. The technique makes the usage of PDS plate safe and reliable.

References

1. Rimmer J, Saleh H. Use of polydioxanone plate in septal reconstruction. Facial Plast Surg. 2013 Dec;29(6):464-72. 



2: 
Rimmer J, Ferguson LM, Saleh HA. Versatile applications of the polydioxanone plate in Rhinoplasty and septal surgery.. Arch Facial Plast Surg. 2012 Sep-Oct;14(5):323-30.


3: 
Petropoulos I, Nolst Trenite G, Boenisch M, Nousios G, Kontzoglou G. External septal reconstructions with the use of polydioxanone foil: our experience. Eur Arch Otorhinolaryngol. 2006 Dec;263(12):1105-8. Epub 2006 Aug 9.


4: 
Gomulinski L. The severely deviated septum- the way I solve the problem. Facial Plast Surg. 2006 Nov;22(4):240-8.