Preventing Blood From Turning To Bone During Rhinoplasty Surgery
Any broken bone in the body heals in the same manner. You bleed it into the area that breaks. That blood forms a clot, what we call a hematoma, and clot that’s adjacent to or beside in the company of bone is affected by the factors, the chemicals, that come out of the bone cells that are residing, in the blood cloud– in the blood clot. As blood vessels grow into it to try and heal the bone, there are cells that you call progenitor cells. And they can become any number of different types of manufacturing cells. They can manufacture cartilage. They can manufacture bone.
They can manufacture fibrous tissue. It just depends on the chemical messages that they’re getting from the surrounding environment, namely the broken bone that’s around. And in the case of a broken arm or a broken leg, the chemicals are saying make bone, make bone. Actually, make cartilage first, and then make bone. It’s no different in a nose. When we break or cut or rasp a nose, we’re essentially causing a hematoma in the vicinity, causing a blood clot, in the vicinity of bone. Same problem, the blood that’s there, is gonna have progenitor cells in it.
The bone surrounding it is gonna send out chemical messages saying, make bone. So it’s critical to ensure that there’s minimal bleeding in the area, particularly in an area where we’re trying to get rid of bone, there’s minimal bleeding. And there’s minimal dust of bone because that bone dust that may arise as a result of sawing or rasping, has all those chemical messages in it. If they’re left in place, there’s a risk that bone will reform and bony bump can reform for instance. So there are a number of things that I do to try and mitigate that. One is to ensure that it’s well washed out after I’ve done any rasping or any breaking of the bone. That’s just done with irrigation.
The other is to ensure, I actually use a power rasp and I think power rasp is a much less destructive means of reducing the bone. The movements are much less gross. They’re refined oscillations. That creates less large fragments of bone and less bleeding in the end. So that’s another measure that I take to try and minimize it. The power rasp I think, is a very good tool. It’s also, in my feeling, a more accurate means of reducing the size. Especially, once again, we’re talking about millimeters.
The other thing I do is, when a patient comes back to me in the first week after surgery, I may actually– The first thing I do is I check to ensure that, once the splint is off, that there’s no build up of blood or fluid underneath the splint and underneath the bandages in that area. And, if there is, I tell the patient to brace themselves, although it’s not that painful. But I actually massage it out. I apply pressure and I try and ensure that I milk or squeeze all of that fluid, blood, potential bone, out of the area. And I find that, once again, it mitigates the risk of reforming bone, potentially having to have a revision for that reason.
Immediately after surgery, still on the operating room table when the surgery is done, one more method of trying to prevent blood from forming and that blood turning into anything other than blood is a good taping. And taping is very, very important, if you– you know, every rhinoplasty surgery has their ritual of taping. Sometimes takes almost as long as the operation. But it’s a very important part of the operation because the taping, which we use steri-strips, medical tape; actually closes off that dead space. It compresses the skin onto the new structure that we’ve created.
It helps control how the skin and the soft tissue is gonna redrape over the new structure that’s been created. And by compressing and trying to obliterate that dead space, as we call it, underneath the skin. It may once again reduce the risk of a hematoma forming and that hematoma potentially resulting in bone formation.