Salvage of Infected Cartilage Grafts for Nasal Reconstruction With a Through-and-Through Irrigation System

Walton, Robert L.; Wu, Liza C.; Beahm, Elisabeth K.

doi:10.1097/01.sap.0000146860.48187.d7

Cited by 10 publications

(7 citation statements)

References 49 publications

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“…Delgado-Lopez et al [11] and Auguste and McDermott [12] succeeded in preserving a previous bone flap using an antibiotic irrigation system. This effective indwelling antibiotic irrigation system has also been shown to be useful for salvaging infected nasal cartilage, in addition to cranial bone flaps [13]. Our case differs from previous reports in which the prosthetic cranial implant was successfully salvaged with an antibiotic irrigation system along with scalp defect reconstruction.…”

Section: Discussionmentioning

confidence: 53%

Salvage of an exposed cranial prosthetic implant using a transposition flap with an indwelling antibiotic irrigation system

Hwang

Chang

2020

Arch Craniofac Surg

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Cranial implant removal is recommended if implants become exposed owing to scalp necrosis after cranioplasty. However, it carries the risk of extensive bleeding, and the resultant cranial defects can cause both aesthetic and functional problems. We present a case of a scalp defect exposing a cranial prosthetic implant that was reconstructed with a local flap and salvaged using an indwelling antibiotic irrigation system. A 73-year-old man presented with scalp necrosis after undergoing cranioplasty due to intracranial hemorrhage. The cranial implant was exposed through the scalp defect. Methicillin-resistant Staphylococcus aureus was detected in the culture from the open wound. After debridement of the necrotic tissue and burring of the superficial layer of the implant, a transposition flap was used to cover the defect and an indwelling antibiotic irrigation system was installed. Continuous irrigation with vancomycin was conducted for 5 days, and intravenous vancomycin was continued for 4 weeks. The flap was in good condition at 4 months postoperatively, with no infection. The convex contour of the scalp was well maintained. The patient's neurological status was stable. Exposed cranial implants can be salvaged with continuous antibiotic irrigation as an alternative to implant removal; thus, the risk of bleeding and possible disfigurement may be avoided.

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Section: Discussionmentioning

confidence: 53%

Salvage of an exposed cranial prosthetic implant using a transposition flap with an indwelling antibiotic irrigation system

Hwang

Chang

2020

Arch Craniofac Surg

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“…According to the authors, a 3-year follow-up demonstrated no recurrence of the nasal infection with complete maintenance of the immediate postoperative shape, function, and aesthetics. 10 The through-and-through apparatus described in the 2 case reports are similar, as is the 7-day period of use with intravenous antibiotics. However, there are major differences (aside from the ages of the patients and the anatomic locations of the costochondral constructs), most notably between the concentrations and types of antibiotics employed (1 mg/1 mL H 2 O of gentamicin sulfate vs a combination of 50,000 U/L of bacitracin and 80 mg/L of gentamicin), the rates of continuous irrigation (5 mL per hour vs 50 mL per hour), and the type of drainage (free gravity vs closed suction).…”

Section: Discussionmentioning

confidence: 97%

“…Washing the exposed portions of the infected cartilage grafts with culture-specific antibiotics has proven effective in the treatment of chondritis of the ear. 9,10 The successful salvage of an infected cartilage graft for nasal reconstruction utilizing a through-and-through irrigation system has been reported in the literature. 10 In the nasal reconstruction salvage case, a 60-year-old patient presented 1 month after a nasal reconstruction with an abscess that lay in direct continuity with the recently placed cartilage spreader grafts, the dorsal onlay graft, and the nasal tip grafts.…”

Section: Discussionmentioning

confidence: 98%

“…9,10 The successful salvage of an infected cartilage graft for nasal reconstruction utilizing a through-and-through irrigation system has been reported in the literature. 10 In the nasal reconstruction salvage case, a 60-year-old patient presented 1 month after a nasal reconstruction with an abscess that lay in direct continuity with the recently placed cartilage spreader grafts, the dorsal onlay graft, and the nasal tip grafts. The authors' first attempt using intravenous antibiotics and daily dressing changes was found to be ineffective, and the patient was taken to the operating room, where a through-an-through irrigation catheter was placed and continuous irrigation with gentamicin sulfate (1 mg/1 mL H 2 O at 5 mL per hour) was administered powered by a continuous-infusion pump commonly used for intravenous infusions.…”

Section: Discussionmentioning

confidence: 98%

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Salvage of a Costochondral Graft for Microtia After Postoperative Infection

Driscoll

Walker²,

D’Achille³

2014

Annals of Plastic Surgery

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Costochondral grafts have been the gold standard for ear reconstruction in cases of microtia repair for decades. Microtia repair has been traditionally associated with a low complication rate, yet little exists in the literature regarding the management of complications when they do occur. Postoperative infections of costochondral grafts have traditionally resulted in complete graft loss, necessitating additional surgery or leaving the patient with continued physical disfigurement and the accompanying psychological and emotional distress. The authors wish to present a case report demonstrating the treatment of a fulminant postoperative infection of a costochondral graft and its cutaneous pocket in a 16-year-old male patient with microtia. In this report, we discuss the successful treatment of the infection and 5 years of follow-up demonstrating the complete salvage of the costochondral construct. This is the first case report on the successful treatment and salvage of an infected costochondral graft in microtia repair.

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“…Acute or late infection in nasal reconstruction usually leads to cartilage loss, soft-tissue collapse, and poor result. 1 …”

mentioning

confidence: 99%

Salvage of Infected Nasal Reconstruction with a Polymethyl Methacrylate Spacer

Cavadas

Thioné

Pacheco

2017

Plastic and Reconstructive Surgery - Global Open

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Summary:Total nasal reconstruction is a challenging multistage procedure. Infections can destroy the cartilage framework and seriously compromise the result. The use of polymethyl methacrylate with antibiotics as a spacer has been described in the treatment of skeletal infections. Using this same principle, the use of a polymethyl methacrylate with antibiotics spacer for an infected nasal reconstruction is reported in a clinical case.

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Salvage of Infected Cartilage Grafts for Nasal Reconstruction With a Through-and-Through Irrigation System

Cited by 10 publications

References 49 publications

Salvage of an exposed cranial prosthetic implant using a transposition flap with an indwelling antibiotic irrigation system

Salvage of an exposed cranial prosthetic implant using a transposition flap with an indwelling antibiotic irrigation system

Salvage of a Costochondral Graft for Microtia After Postoperative Infection

Salvage of Infected Nasal Reconstruction with a Polymethyl Methacrylate Spacer

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