[Surgical treatment of rhinophyma with the ultrasonic scalpel (Ultracision Harmonic Scalpel)].
BACKGROUND
There are multiple surgical approaches to the treatment of rhinophyma. Because of the exceptional vascularity of the nose, traditional surgical approaches to the management of rhinophyma are fraught with persistent intraoperative hemorrhage. Hemorrhage that is controlled with electrocautery or laser by a combination of excision of rhinophymatous tissue and simultaneous hemostasis invariably damages cartilage by thermal injury. The UltraCision Harmonic Scalpel achieved a tissue dissection with a simultaneous hemostasis and only minimal thermal tissue injury. To this date, in Europe no studies have been published on the use of the Ultracision Harmonic Scalpel in the surgical treatment of rhinophyma.


METHODS
6 patients had surgical treatment of rhinophyma with the UltraCision Harmonic Scalpel. The objective of the study was therefore to analyse the handling indication, the efficiency of intra- and postoperative hemostasis, the wound healing, the postoperative pain and the histologic results of tissue resections.


RESULTS
Because of the effective intraoperative hemostasis supplementary hemostasis was not required in any examined patient. The efficient hemostasis and the tactile experience of the UltraCision Harmonic Scalpel enabled an accurate sculpting of the nose. Postoperative pain sensation was minimal. Wound healing was uneventful in all cases. Postoperative reepithelialization occurred within 28 days. Delayed complications like scarring did not occur within a median follow - up of 13 month. Histopathological evaluation was possible in all cases.


CONCLUSIONS
The UltraCision Harmonic Scalpel offers a surgical treatment of rhinophyma with efficacious intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. Based on its mechanical function, the UltraCision Harmonic Scalpel has only a little thermal effect on neighbouring tissues and a good tactile experience that enables a controlled tissue resection. The UltraCision Harmonic Scalpel combines the advantages of tissue dissection and simultaneous hemostasis with the controlled handling of the traditional scalpel in rhinophyma surgery.
Metternich
F U
FU
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde des Universitätsklinikums Hamburg-Eppendorf, Hamburg. metterni@uke.uni-hamburg.de
Wenzel
S
S
Sagowski
C
C
Jäkel
K
K
Koch
U
U
D000368:Aged; D062109:Dermatologic Surgical Procedures; D004867:Equipment Design; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D012224:Rhinophyma / Q000473:pathology / Q000601:surgery*; D012225:Rhinoplasty / Q000295:instrumentation*; D012867:Skin / Q000473:pathology; D013525:Surgical Instruments; D014464:Ultrasonic Therapy / Q000295:instrumentation*