Outcomes of a Treatment Protocol for Compromised Nasal Skin in Primary and Revision Open Rhinoplasty

Overview

Lifting the skin off the nose in open rhinoplasty can threaten its blood supply. This retrospective chart review of one surgeon's private patients examined how often that happened, whether it could be predicted, and what the outcomes were after treatment. All cases showing vascular compromise that required treatment were analysed.

Sections of note

• Retrospective chart review of 384 open rhinoplasties performed between October 1, 2015, and December 31, 2018.
• One hundred and nine were primary rhinoplasties and 275 were revision rhinoplasties.
• Twenty seven cases, 7 percent, had skin compromise requiring unplanned postoperative treatment; 2 were primary, 7.4 percent, and 25 were revision, 92.6 percent.
• Advanced age, P less than 0.0001, prior or current smoking, P equals 0.027, and a greater number of previous rhinoplasties, P equals 0.0002, correlated significantly with risk.
• Average time to last follow up in the affected group was 392 days, range 15 to 1057.
• Twelve of the 27 patients, 44.4 percent, had complete resolution with no further treatment needed.
• The revision rate among patients with skin compromise was 22.2 percent.
• One patient had revision surgery directly related to skin compromise and one is considering it.

What it means for a patient

• Skin blood supply problems were uncommon overall but concentrated almost entirely in patients who had already had nasal surgery.
• Smoking and older age were associated with higher risk.
• Prompt treatment saved the skin in most cases, though under half resolved completely without further treatment.
• This is one surgeon's practice with a high proportion of revision cases, so the 7 percent rate may not apply elsewhere.

Why this paper matters

Skin loss on the nose is among the most damaging rhinoplasty complications and is difficult to correct. This study is the first the authors identify to report its incidence and treatment outcomes after open rhinoplasty. Which specific treatment steps produced the salvage is not separated out.

Terms

• Open rhinoplasty: surgery through an incision across the columella, lifting the nasal skin.
• Vascular compromise: reduced blood supply to tissue, which can cause skin breakdown.
• Skin necrosis: death of skin from lack of blood supply.
• Revision rhinoplasty: surgery on a nose that has already been operated on.
• Retrospective chart review: analysis of existing medical records after treatment.