Reconstruction of the nasal septum using perforated and unperforated polydioxanone foil.

OBJECTIVE To present our experience of reconstruction of the nasal septum using perforated and unperforated foils, particularly with respect to functional and aesthetic sequelae. METHODS A retrospective medical record review of a prospectively conducted case series was undertaken of all consecutive patients who underwent septal reconstruction using polydioxanone foil in a 4-year period. Procedures included septorhinoplasty and isolated septoplasty via external and endonasal approaches using corporeal and extracorporeal techniques. The polydioxanone foils were in battens or sheets. RESULTS Fifty patients underwent septal reconstruction using unperforated (first 26 patients) or perforated (next 24 patients) polydioxanone foil. Median total postoperative follow-up was 51.5 months (range, 34-60 months) for unperforated foil and 20.5 months (range, 12-31 months) for perforated foil. All the patients were reviewed for assessment of appearance and function. Forty-three patients had satisfactory results, needing no further treatment. Three patients required minor septal or tip revision surgery. Four patients experienced moderate saddling of the dorsum (all involved unperforated polydioxanone foil) and underwent successful revision surgery using auricular cartilage grafts. CONCLUSIONS Synthetic materials are a useful alternative to autologous tissues during reconstruction of the nasal septum. To our knowledge, we present the largest single-center series of septal reconstructions using unperforated and perforated polydioxanone foils-shown to be useful in the correction of complex septal deformity. However, the unperforated form seems to be associated with a significant risk of postoperative saddling, and we warn against its use in this context. No such complications were observed with the use of thin, 0.15-mm perforated polydioxanone foil, which we exclusively recommend for this application. The use of this implant warrants further evaluation.