Disastrous Complications Following Rhinoplasty: Soft Tissue Defects

Abstract

Background: Rhinoplasty has become one of the most frequently performed worldwide aesthetic procedures thanks to the successful results obtained by plastic surgeons. In this study, soft tissue defects, encountered as an undesirable and fearsome complication following rhinoplasty, its causes and precautions are presented by authors. Materials and Methods: Eight patients operated between December 2015 and December 2018 were enrolled in this study. According to the causes of soft tissue defects observed following rhinoplasty; patients were examined in 5 groups consisting of excessive subcutaneous adipose tissue defatting, improper dissection plane, compression of cast, splint and strip materials, pressure applied to skin by cartilage grafts, and overresection. Results: Herein, while subcutaneous excessive defatting and intense cigarette smoking was responsible of the necrosis in the first patient we defined, high pressure on skin due to tight bandaging or external splint materials lead to skin necrosis in our patients 2, 3, and 4. The 5th and 6th patients were candidates of a revision rhinoplasty; however, both resulted with necrosis probably by reason of inaccurate dissection and/or possible diminished vascularity by previous rhinoplasty operations. In the 8th patient, necrosis was observed due to the compression of the bulky autologous cartilage graft used in the skin. Conclusion: In conclusion, skin necrosis is a rare but bothersome complication of rhinoplasty. The importance of atraumatic techniques and appropriate dissection plane during the rhinoplasty operation as well as the importance of the effect and control of the postoperative applied splint and bandage materials is so obviously seen.

Skin Necrosis Following Rhinoplasty: A Review and Proposed Strategy on Identifying High-Risk Patients

“…Depending on the size of dorsal skin loss, patients required dorsal graft removal, debridement, and secondary interventions. 12,15,16 Luckily, the overall rate of this complication remains low at 0.9% as reported by Eskitascioglu and Kemaloglu. 12 Patterns of cutaneous ischemia and loss would typically follow arterial angiosome which can be variable.…”

“…Consequently, the choice of splinting material and amount of pressure applied rely on surgeon's clinical judgment. Ersek 10 and Bilgen et al 16 reported thermal injury to nasal dorsum and the supratip area from their use, leading to ischemia and necrosis. To avoid this complication, surgeons should strongly consider applying thermoplastic splints less tightly especially if dorsal onlay grafts are utilized.…”

“…Treatment of necrotic areas included conservative wound care or healing by secondary intention, local flap closure, excision of necrotic area, and removal of cartilage grafts as well as topical nitroglycerin for salvageable ischemia. [9][10][11][12][13][14][15][16] The majority of patients (93.1%) who were available for follow-up were initially managed with conservative wound management. One patient benefited from intraoperative identification of ischemia with SPY angiography and was salvaged with topical nitroglycerin applied twice per day for a total of 5 days.…”

“…Out of the 18 patients described in the studies, 5 patients experienced necrosis from injury related to the postoperative nasal splinting or taping. 15,16 Significant subcutaneous tip thinning was also shown to be a potential etiology in necrosis. 16 Most case presentations lacked description of past medical health issues that could have been contributory.…”

“…15,16 Significant subcutaneous tip thinning was also shown to be a potential etiology in necrosis. 16 Most case presentations lacked description of past medical health issues that could have been contributory. Smoking was associated with cutaneous necrosis in 23.5% of reported cases (►Table 1).…”