Wound Healing in External Rhinoplasty-The Effect of Fibrin Glue on Dead Space Closure: A Retrospective Propensity Score-Matched Study

Introduction: The presence of "dead space" in external rhinoplasty creates a welcoming environment for erratic soft tissue contraction. Poor redraping of the skin over the underlying osseocartilaginous framework at the end of the surgery may result in its creation. If surgeons can control and reliably predict skin contraction and wound healing, septorhinoplasty results would undoubtedly improve. Fibrin glue application has previously demonstrated a reduction in adverse events in plastic surgery. Several potential advantages have been attributed to the application of fibrin glue, such as reducing downtime, improving patient satisfaction and reducing complication rates.

Objective: To evaluate the effectiveness of homologous fibrin glue on the long-term healing process in external rhinoplasty.

Material and methods: We performed a retrospective propensity score-matched analysis in 154 patients enrolled for external septorhinoplasty. An aesthetic evaluation was performed with the FACE-Q nose and nostrils, the Utrecht Questionnaire including VAS score and the NOSE. Assessments were conducted prior to surgery and post-operatively at 3, 6 and 12 months. After propensity score matching, two equal groups of 66 patients were retained. The first cohort of 66 patients underwent a rhinoplasty without the application of fibrin glue; in the second cohort of 66 patients, human fibrin glue was used to achieve better adherence of the skin to the underlying skeletal framework.

Results: All patients had a statistically highly significant improvement on all PROMs post-operatively. The post-operative results remained stable over the different time points. However, no statistically significant difference in the aesthetic outcome was discovered whether fibrin glue was used or not during surgery.

Conclusions: Obliteration of dead space is a key component in septorhinoplasty as it minimizes soft tissue contraction, resulting in a more predictable outcome. Although fibrin glue has been used successfully in different medical fields, no long-term positive effects on patient satisfaction could be detected in the present study.

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