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Septal Perforation Repair With Acellular Human Dermal Allograft

Russell W. H. Kridel, MD; Hossam Foda, MD; Kevin C. Lunde, MD

TO ACHIEVE a 90% or greater success rate with repairs of septal perforation in patients with perforations less than 3 cm requires not
only bilateral repair of the mucoperichondrial flaps via transposition of the flaps with suture closure of the previous existing defect, but also the interposition of a connective tissue autograft between the repaired flaps. Numerous autografts have been used for this purpose; the most favored grafting material is temporalis fascia. Pericranium and mastoid periosteum have been used less often but with similar success rates.

Temporalis fascia and pericranium are extremely thin grafts with very low metabolic requirements and have been shown to act as excellent templates for overlying tissue migration and vascularization. Mastoid periosteum has been used with the hope of adding bulk to the thickness of the resultant repaired septal membranes. It also has been used with the still unproved hope that bone might be regenerated between the septal flaps. The need for a connective tissue interpositional graft is generally accepted by all authors who use intranasal mucosal flap advancements. The interposed graft maintains a barrier between the corresponding repaired flaps during healing and, therefore, decreases the risk of incisional breakdown and reperforation.

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SEPTAL PERFORATION PRESENTATION AND RECONSTRUCTION

RUSSELL W. H. KRIDEL, MD

In most facial plastic or otolaryngology practices,patients with septal perforations are most commonly seen both with and without symptoms after previous nasal or sinus surgery,nasal picking,or after cocaine use.Although these are the most common causes,a clear-cut etiology must be established from a long list of potential causes, some of which can be life-threatening.Septal perforation repair is technically challenging because the perforation represents a hole in three distinct tissue layers:the right and left septal mucoperichondrial flaps and the absent intervening cartilage.Both mucoperichondrial flaps,which are usually adherent to each other, must be distinctly separated and repaired individually, and the space in between should be filled with a connective tissue graft.

Although many procedures have been described to repair septal perforations,those techniques resulting in the highest success rate, best physiologic outcome, and best patient acceptance generally require using extensively mobilized,bilateral,intranasal mucosal advancement flaps and interposition and anchoring of a connective tissue-type graft. The success of repair is directly related to the size ofthe perforation,the presence or absence of scarr ing, metaplasia or inflammation,and the surgeon’s experience. Because this repair is so difficult, prevention is always the best alternative.

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Rodeo Rhinoplasty Houston Texas 2010

"Lemme get a gander at that there schnozzle under your Stetson, partner" might be overheard this week in Houston during Rodeo Rhinoplasty, four days of physician training on every aspect of the nose job.

Houston’s racial and ethnic diversity - providing an international range of noses - makes the city an ideal location for a seminar exploring surgical techniques and modern beauty standards, said Dr. Russell Kridel, a Houston plastic surgeon who founded the annual conference last year.

"What we think is beautiful is changing," he said. "We have to know that so we can achieve what that beauty is. You can’t think that everyone wants to have a long, thin nose.

Read the story here:
http://www.chron.com/disp/story.mpl/metropolitan/6909552.html

Rodeo Rhinoplasty Houston Texas 2010

By CINDY GEORGE
HOUSTON CHRONICLE
March 11, 2010, 10:13PM

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Dr. Kridel congratulated for a landmark study in the November- December issue of AMA Archives of Facial Plastic Surgery

From the 10th anniversary issue of Archives of Facial Plastic Surgery, editor Wayne Larrabee Jr, MD: “Long-term Use and Follow-up of Irradiated Cartilage Grafts in the Nose epitomizes the meticulous clinical observation that we all should strive to achieve in our practices. Russell W. H. Kridel, MD and colleagues performed a meticulous study of 357 patients with a 24-year follow up. This study by Kridel et al is important not only for the standard it sets in careful clinical evaluation, but also for the importance of the subject. Their results will cause many to reevaluate the role of irradiated cartilage in their practices.”

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