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Acellular Porcine Dermal Collagen Implant in Saddle Nose Deformity

Lo, Stephen M.D., M.B.A., B.Med.Sc.; Kenway, Bruno M.R.C.S., D.O.H.N.S.; Hosni, Asaad F.R.C.S.(O.R.L.-H.N.S.)

Plastic and Reconstructive Surgery: August 2011 - Volume 128 - Issue 2 - p 82e-84e
doi: 10.1097/PRS.0b013e31821ef15f

Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore (Lo)

Department of Otorhinolaryngology, Frimley Park Hospital, Surrey, United Kingdom (Kenway, Hosni)

Correspondence to Dr. Lo, Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore,

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Autologous cartilage has been widely accepted as the most ideal graft material in augmentation rhinoplasty for the saddle nose. However, there are situations when cartilage is inadequate in quantity or donor-site morbidity is unacceptable to the patient. The use of Permacol (Tissue Science Laboratories, Aldershot, United Kingdom) has been described in various surgical disciplines, and has recently gained popularity in facial surgery, such as facial recontouring, lip reconstruction, and rhinoplasty.1–3 Permacol is an acellular, biological, permanent, nonresorbable porcine collagen implant. It was originally designed for permanent implantation in humans. Structurally, it is similar to the architecture of the human dermis, and it has been shown to be readily invaded by host tissue cells and blood vessels.3–5 We report our series of all consecutive patients who underwent augmentation septorhinoplasty for saddle nose over a 7-year period (2001 to 2008). Autogenous septal cartilage was used whenever possible. The Permacol sheets were cut into the desired shape and size. The implant could be stacked into layers of different thicknesses using a 5-0 Monocryl (Ethicon, Inc., Somerville, N.J.) mattress suture. Two further 5-0 Monocryl sutures were used to secure the caudal and cephalic ends of the graft passing through the nasal dorsal skin inside-out, with the ends taped to the nasal skin, and were shortened to skin 1 week after surgery.

Permacol was used in 42 patients with a saddle nose (two patients with septal perforation, four patients with previous rhinoplasty, and the remaining patients with a history of nasal trauma). The median age of the patients was 30 years (range, 17 to 62 years). Seventeen septorhinoplasties were performed using the open approach and 25 septorhinoplasties were performed with the closed approach. Thirty-eight patients underwent primary surgery. Concurrent dorsal hump reduction occurred in 17 patients, septoplasty occurred in 31 patients, osteotomies occurred in 36 patients, and nasal tip sculpture occurred in 27 patients. Table 1 lists different thicknesses of Permacol used for augmentation (Fig. 1).

Table 1

Table 1

Fig. 1.

Fig. 1.

The mean postoperative follow-up duration was 26 months. No significant complications have been reported, such as infection, displacement, discoloration, or extrusion. Moderate resorption (<50 percent) has been observed in two patients only, whose original implants were 3 and 4.5 mm, respectively. These two patients did not present with any local or systemic risk factors that might have affected wound healing.

Our experience with nasal augmentation using Permacol in saddle nose deformity is encouraging. The material can be easily handled and shaped. Because of its soft consistency, it does not cause sharp edges or rigidity under the nasal skin envelope. Resorption is minimal and it is not necessary to overcorrect the defect intraoperatively. Postoperatively, the implant does not shift, as it can be sutured in place, and no infections have been observed. We recommend this approach in patients seeking rhinoplasty who do no have sufficient donor septal or auricular cartilage and will not accept autogenous graft donor-site morbidity or irradiated cadaveric homogeneous grafts. However, patient refusal of implant material derived from porcine tissue is a potential disadvantage.

Stephen Lo, M.D., M.B.A., B.Med.Sc.

Division of Facial Plastic Surgery

Department of Otorhinolaryngology

Tan Tock Seng Hospital


Bruno Kenway, M.R.C.S., D.O.H.N.S.

Asaad Hosni, F.R.C.S.(O.R.L.-H.N.S.)

Department of Otorhinolaryngology

Frimley Park Hospital

Surrey, United Kingdom

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The patient provided written consent for the use of his images.

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1. Hopkins C, Walker R, Lee S, Roberts D. Permacol in augmentation rhinoplasty: How we do it. Clin Otolaryngol. 2009;34:68–75.
2. Benito-Ruiz J, Guisantes E, Serra-Renom JM. Porcine dermal collagen: A new option for soft-tissue reconstruction of the lip. Plast Reconstr Surg. 2006;117:2517–2519.
3. Saray A. Porcine dermal collagen (Permacol) for facial contour augmentation: Preliminary report. Aesthetic Plast Surg. 2003;27:368–375.
4. Cosson M, Boukerrou M, Lobry P, et al. Mechanical properties of biological or synthetic implants used to treat genital prolapse and stress incontinence in women: What is the ideal material? (in French). J Gynecol Obstet Biol Reprod (Paris) 2003;32:321–328.
5. Salomon LJ, Detchev R, Barranger E, Cortez A, Callard P, Darai E. Treatment of anterior vaginal wall prolapse with porcine skin collagen implant by the transobturator route: Preliminary results. Eur Urol. 2004;45:219–225.

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