Skin Necrosis following Rhinoplasty

Mrad, Mohamed Amir; Almarghoub, Mohammed A.

doi:10.1097/gox.0000000000002077

Cited by 9 publications

(12 citation statements)

References 9 publications

(10 reference statements)

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“…After survey of the literature, we identified eight articles that discussed necrotic complications after surgical rhinoplasty. [9][10][11][12][13][14][15] Included articles were composed of case reports and series. The overall quality of evidence of the articles was low (stage IV) based on the Oxford Centre for Evidence-Based Medicine.…”

Section: Resultsmentioning

confidence: 99%

“…This mechanism was attributed to cutaneous necrosis seen in four (22.2%) patients. 12,15,16 In all but one patient, the dorsal onlay cartilage grafts were removed and the wound was allowed to heal by secondary intention. Depending on the size of dorsal skin loss, patients required dorsal graft removal, debridement, and secondary interventions.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Etiologymentioning

confidence: 99%

“…12 Mrad and Almarghoub reported on a 34-year-old female patient who underwent secondary rhinoplasty, where a similar technique was employed and paired with a metal splint placed postoperatively. 15 Combination of the dorsal onlay with tight splitting led to the necrosis of the dorsum. Therefore, surgeons should be cautioned about tight splint application in a setting of dorsal onlay grafts.…”

Section: Etiologymentioning

confidence: 99%

“…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.…”

Section: Managementmentioning

confidence: 99%

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

et al. 2021

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Vascular compromise leading to cutaneous loss following surgical rhinoplasty is a devastating complication. The objective of this review is to identify all reported cases in literature published in English and summarize the current evidence to identify the patients at risk of this complication following surgery. A comprehensive literature review using Medline and Embase databases was performed to capture all reported cases of cutaneous vascular compromise following rhinoplasty from database inception through September 2020. Nonsurgical rhinoplasty cases were excluded. We identified eight studies that featured vascular cutaneous compromise following surgical rhinoplasty. A total of 18 patients were included in the analysis. The majority of the patients were females with a mean age of 30.9. Risk factors included smoking in 23.5% patients and revision setting. Extensive tip thinning, tight splinting and taping with dorsal onlay grafting, or combining extended alar base excision with revision open rhinoplasty were among surgical techniques associated with vascular compromise. The most commonly affected aesthetic nasal subunit in our review was the dorsum followed by the nasal tip. Conservative management primarily was utilized in 72.2% of patients, allowing the defect to heal by secondary intention. Studies reporting on cutaneous vascular compromise following surgical rhinoplasty are of low level of evidence. This review is the largest summary reporting on this complication to date, aiming to caution surgeons about associated techniques and management options. We also share an expert opinion on preoperative assessment of nasal skin to guide surgeons to potentially avoid rhinoplasty surgery in this subset of patients.

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