New Strategies For Prevention Of Postoperative Infection After Implanting Expanded Polytetrafluoroethylene(e-PTFE) Prosthesis In Rhinoplasty

Research background:"The nose is the Zhongyue,the focus of the face".The position of the nose is in the middle of the face,which is the most prominent area of a face.The shape of a nose directly affects the overall facial department of stereo vision.Therefore,nose is regarded as the most concerned facial organ among people.In recent years,more and more people are looking for beauty by rhinoplasty,and rhinoplasty has become more and more diversified.Hence,the technical requirements for plastic surgeons become higher and higher.Two decades ago,silicon rubber was the main implant material in rhinoplasty.Then,expanded polytetrafluoroethylene(e-PTFE)and autologous cartilage were developed,and the implantation materials become more optional,involving the adjustment of multiple nose subunits for integrated rhinoplasty techniques.With the increase of surgical cases and the prolongation of follow-up,the number of cases with complications increased.During the past 10 years,e-PTFE has become a popular implant materials due to its excellent histocompatibility,non-slidability,and poor light transmission.However,some domestic and foreign doctors think that the infection rate after e-PTEF implantation is high and it should be avoided.In the existing literature,there are many reports about the complications and prevention methods of silicone rubber prosthesis implantation.However,few studies investigated the risk factors associated with complications after e-PTFE prosthesis implantation,and we are lack of effective prevention and treatment measures after e-PTFE prosthesis implantation.Materials and Methods:We collected all cases received implantation of e-PTFE prosthesis between January 2007 and December 2015 in our hospital and following up for 1 year for retrospective analysis.The patients with a history of nasal fractures,cleft lip,broad nose,and hump nasal were excluded,eventually 1212 cases were included.We regarded the following factors,patient’s gender,age,surgical method,previous nasal surgery,whether the pores have excessive sebum secretion in the nose,whether the cartilage cap transplantation have been performed at the tip of the nose,whether the support of the columella is elevated,and whether the nasal septum have been performed,whether the cartilage have been cut,whether the nasal septum extension have been transplanted,whether the nasal fat pad has been removed,whether the alar cartilage has been treated,whether the nasal wing has been narrowed,whether the drainage tube is left after operation,whether there is severe swelling after operation,whether the antibiotic has been used to prevent infection after surgery,whether there was folliculitis in the postoperative nose,whether there was collision in the nose after operation,and postoperative nasal mucosa injury,as the related risk factors,and a multi-factorial logistic regression model was constructed to analyze the independent risk factors for postoperative infection.Results:Univariate analysis was performed by successively calibrated Chi-Square test and Fish Precision Orthopaedic test.The results showed that previous history of nasal surgery,enlarged nasal pores,alar cartilages,postoperative nasal folliculitis,and postoperative nasal vestibular mucosa breakage were the risk factors for infection after rhinoplasty with implanting e-PTFE prostheses(p<0.05).Then,the five statistically significant factors were included in the logistic regression model by multivariate analysis.It was concluded that gross sebaceous hypersecretion of nasal pores and intraoperative alar cartilages were the independent risk factors for postoperative infections(p<0.05).Conclusion:The patients with excessive secretion of sebum in the pores of the nose are prone to occur the postoperative infection.The free and partial removal of the alar cartilage in the operation will increase the risk of postoperative infection.Combined with clinical experience,in order to better prevent the occurrence of infections after implantation of e-PTFE prostheses in rhinoplasty,the following new principles of clinical practice are formulated:1.Preoperative cases selection should exclude the one with excessive sebum secretion from the pores of the nose,especially at the onset of inflammation in the nasal follicle;2.Surgical procedures must be performed under the aseptic environment;3.Prosthetic antibacterial treatment:with the treatment by antibiotics or bactericidal solution containing gentamycin or diluted povidone iodine,and negative pressure soaking treatment;4.To avoid contact between the nose follicle and the prosthesis,reduce the exposure of the nasal vestibular hair follicle;5.Reduce the surface tension of the prosthesis,firmly fix the position of the prosthesis;6.Attention to prevention of bleeding during surgery,left postoperative indwelling drainage;7.Postoperative follow-up,deal with symptoms properly and timely.