Is Piezoelectric Surgery Really Harmless to Soft Tissue?

Aim: The aim of this study was to investigate the effect of piezoelectric surgery (piezosurgery) on soft tissue in open septorhinoplasty. Methods: A total of 30 patients (21 females, 9 males; mean age 29.16 +/- 8.17 years; range, 18-43 years) who underwent open septorhinoplasty between January 2019 and February 2019 were randomly divided into 2 groups. After the nasal dorsum was opened in all groups, 1 mm(3) tissue under the skin in radix region was taken as punch biopsy. In the first group (classical group, n = 15), the cartilage hump was resected with number 15 scalpel and the bone hump with the help of a chisel. Lateral and median osteotomies were conducted using 4 mm sharp osteotomes. Rasping was performed to dorsum to correct bone deformities. Then, 1 mm(3) punch biopsy was taken from under the skin tissue of the nose back near the radix. In the second group (piezo group, n = 15) hump excision, osteotomies and rasping were performed by piezoelectric surgery. Then, 1 mm(3) punch biopsy was taken from the subcutaneous tissue of the nose back near the radix. Biopsies were examined histopathologically in the light microscope for edema, necrosis, and inflammation. Results: Of the 30 patients presented in this series, 21 were female and 9 were male. In the classical group, edema in the soft tissue was seen in 86.7% of the cases after osteotomy, while this rate was 26.7% in the piezosurgery group. The difference was statistically significant (P < 0.05). Although necrosis was not seen prior to the osteotomy in both groups, the rate of necrosis in the classical group was 13.3% and in the piezo group it was 66.7%. Necrosis was significantly different in the piezosurgery group compared with the classical osteotomy group (P < 0.05). Conclusion: Piezosurgery is not completely harmless to soft tissue. A statistically significant increase in subcutaneous necrosis compared with the classical group can be explained by long-term soft tissue trauma caused by piezoelectric vibrations. We think that developing necrosis may cause problems in late period, especially in patients with thin skin.