[Experience in using regenerative technologies in the treatment of patients with nasal septum perforation]

Traditional methods of nasal septum perforation surgery using vascularized flaps are quite effective, but at the same time they are associated with a long postoperative period (8-16 weeks), the risk of an inflammatory reaction, uncontrolled scarring in the area of the donor site. According to the literature, the use of collagen membranes and stem cells reduces the period of restoration of the integrity of the nasal septum to 4-6 weeks, but these methods remain expensive and inaccessible. An alternative may be autologous platelet growth factors that stimulate tissue repair and are already used in various branches of medicine. A study of the effectiveness and safety of the use of biocomposite materials in the surgical treatment of nasal septum perforation was conducted at the Sverzhevsky Research Clinical Institute of Otorhinolaryngology.

To evaluate the effectiveness and safety of using biocomposite structures based on type I collagen and platelet-rich plasma lysate in the treatment of patients with nasal septum perforation.

The study included 40 patients diagnosed with perforation of the nasal septum who underwent plastic closure of a defect in the nasal septum with a displaced flap of the mucous membrane of the bony nasal septum and the floor of the nasal cavity. Depending on the covering/non-covering of the donor site with a biocomposite structure, patients are divided into two groups. In group A patients (n=20), the donor site in the area of the nasal septum and nasal cavity floor remained intact and uncovered; in group B patients (n=20), a biocomposite structure with platelet-rich plasma lysate was installed on the donor site in the area of the mucosal defect. The patients of both study groups underwent standard postoperative therapy. Regeneration was assessed according to five parameters of the visual analogue scale (VAS): epithelialization, the presence of hemorrhagic discharge, crusts, inflammatory reaction, and tissue integration. The follow-up period was 10 weeks. During the entire follow-up period, patients completed the SNOT-22 questionnaire to assess the quality of life of patients in the postoperative period.

Group B patients showed a reduction in the regeneration time of the donor portion of the nasal mucosa by 2 weeks compared with group A patients. As early as 6 weeks after surgery, group B patients achieved complete epithelialization (VAS score = 3.0 [2.0; 4.0]), whereas 45% of group A patients retained areas of exposure. bones in the area of the donor site with the formation of granulation tissue (VAS score = 5.0 [4.0; 6.0], p<0.001), and a good regeneration result was noted only after 8-9 weeks (VAS score = 3.5 [3.0; 5.0], p<0.001). The decrease in the SNOT-22 score in group B patients correlated with the dynamics of the VAS score (Rs=0.908, p<0.001): already at week 2, the difference in the SNOT-22 score between the groups was -5.78 [-7.88; -4.79] (p=0.047), which corresponds to a faster improving the quality of life of patients. By week 8, the median SNOT-22 score in group B reached 6.59 [4.33; 9.34], which is 62% lower than in group A (14.72 [12.06; 18.51], p<0.001).

The use of regenerative technologies in combination with irrigation of the mucous membrane is more effective than generally accepted methods in all respects: it reduces the healing time by 20-35%, reduces the duration of inflammation, and provides more stable clinical results. However, the use of biocomposite structures based on collagen and platelet-rich plasma lysate is a more accessible technique and allows achieving similar results with lower financial costs.