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Outcomes of a Treatment Protocol for Compromised Nasal Skin in Primary and Revision Open Rhinoplasty.
- Source :
-
Facial plastic surgery & aesthetic medicine [Facial Plast Surg Aesthet Med] 2021 Mar-Apr; Vol. 23 (2), pp. 118-125. Date of Electronic Publication: 2020 Oct 15. - Publication Year :
- 2021
-
Abstract
- Importance: This is the first study to review the incidence of nasal skin compromise after open rhinoplasty surgery and outcomes of treatment. Objectives: To determine whether risk of skin compromise after open rhinoplasty surgery can be predicted and whether our treatment protocol led to acceptable outcomes. Design, Setting, and Participants: This is a retrospective chart review of the senior author's private patients. In total, 384 rhinoplasty cases were reviewed and all cases with signs of vascular compromise requiring treatment were analyzed. Main Outcomes and Measures: Descriptive statistics were used to evaluate characteristics of patients who developed intra- and postoperative skin compromise, and unpaired two-tailed t -test was used to compare the characteristics of patients with and without compromised nasal skin when possible. Overall satisfaction results and complications in the skin compromise group were reported. Results: A total of 384 open rhinoplasties were performed by the senior author between October 1, 2015, and December 31, 2018. Of them, 109 were primary rhinoplasties and 275 were revision rhinoplasties. Of the 384 rhinoplasties, 27 (7%) had skin compromise leading to unplanned postoperative treatment. Two of the patients in the skin compromise group underwent primary surgeries (7.4%) and 25 underwent revision procedures (92.6%). Advanced age ( p < 0.0001), prior or current history of smoking ( p = 0.027), and greater number of prior rhinoplasty surgeries ( p = 0.0002) were significantly correlated with risk of skin compromise. The average time to last follow-up in the skin compromise group was 392 days (range 15-1057 days). At their last follow-up, 12 patients had complete resolution of all signs of nasal skin compromise with no further treatment required (44.4%). The revision rate for patients experiencing skin compromise was 22.2%. One patient underwent revision surgery directly related to a complication of skin compromise and one is considering revision directly related to skin breakdown. Conclusions and Relevance: The rate of skin compromise after open rhinoplasty is low. Older patients and patients with more prior rhinoplasty surgeries may be at increased risk. Prompt treatment of compromised nasal blood supply after rhinoplasty surgery can salvage skin in most patients.
- Subjects :
- Adolescent
Adult
Aged
Case-Control Studies
Clinical Protocols
Combined Modality Therapy
Female
Humans
Ischemia diagnosis
Ischemia epidemiology
Ischemia etiology
Ischemia therapy
Male
Middle Aged
Patient Satisfaction
Postoperative Complications diagnosis
Postoperative Complications epidemiology
Postoperative Complications etiology
Reoperation
Retrospective Studies
Risk Factors
Skin pathology
Skin Diseases diagnosis
Skin Diseases epidemiology
Skin Diseases etiology
Treatment Outcome
Young Adult
Postoperative Complications therapy
Rhinoplasty methods
Skin blood supply
Skin Diseases therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2689-3622
- Volume :
- 23
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Facial plastic surgery & aesthetic medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33054380
- Full Text :
- https://doi.org/10.1089/fpsam.2020.0181