Area and Severity of Bleeding after Nasal Dermoplasty in Patients with Hereditary Hemorrhagic Telangiectasia

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  • オスラー病の鼻出血に対する鼻粘膜皮膚置換術後にみられる再出血部位の検討
  • オスラービョウ ノ ハナ シュッケツ ニ タイスル ハナ ネンマク ヒフ チカン ジュツゴ ニ ミラレル サイシュッケツ ブイ ノ ケントウ

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Abstract

<p>　Nasal dermoplasty (ND) is an effective method for reducing the frequency and severity of epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). However, because of the nature of the surgical technique, this procedure is accompanied by nasal bleeding even postoperatively. Decreasing bleeding, however, provides a better quality of life for the patients. Therefore, amelioration of the surgical approach to reduce the incidence of epistaxis is desired. This requires detailed and accurate information on the recurrence of bleeding after ND. To the best of our knowledge, such a study has never been performed. In this article, we report the results of a retrospective review of the area and frequency of bleeding after ND at various stages.</p><p></p><p>　Ninety-one patients who underwent ND, performed or supervised by the author at Tokyo University Branch Hospital, The University of Tokyo Hospital, Jichi Medical University Hospital, and Ishibashi General Hospital, were included. The area and frequency of bleeding were surveyed 2 months postoperatively and later. Patients were divided into the following four groups according to the chronological stage of ND/surgical technique employed: Group 1, split-thickness skin was grafted on the anterior septum and inferior turbinate; Group 2, a skin graft was placed on the anterior nose circumferentially; Group 3, the graft take was extended to the nasal vestibule; Group 4, group with septal perforation, in which the MW method, a modified method devised for patients with septal perforation, was adopted.</p><p></p><p>　The most frequent bleeding sites were the anterior part of the nasal septum, rim (especially the posterior rim) of the septal perforation, and nasal vestibular skin. These areas are also the main reasons for reoperation. The incidence of postoperative bleeding and the resultant reoperation declined with the stage, implying that phased enlargement of the skin graft yielded a favorable outcome.</p><p></p><p>　Despite the difficulty in complete eradication, reduction in the frequency and severity of epistaxis following ND is important. Widening of the grafted skin area ensures reduction of epistaxis and of the resultant revision surgery.</p>

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