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

Overview

Loss of skin from failed blood supply after rhinoplasty is a damaging complication. This review searched Medline and Embase from database inception through September 2020 for all reported cases of skin vascular compromise after surgical rhinoplasty, excluding filler cases. The aim was to summarize the evidence and identify who is at risk.

Sections of note

• Literature review; eight studies were identified, covering 18 patients in total.
• Most patients were female, with a mean age of 30.9 years.
• Smoking was present in 23.5 percent of patients, and revision surgery was a risk factor.
• Surgical techniques associated with vascular compromise included extensive tip thinning, tight splinting and taping with a dorsal onlay graft, and combining extended alar base excision with revision open rhinoplasty.
• The most commonly affected area was the bridge, followed by the tip.
• Conservative management was used in 72.2 percent of patients, allowing the wound to heal on its own.
• The authors state the underlying studies are of low level of evidence.
• They add an expert opinion on assessing nasal skin before surgery to identify patients in whom rhinoplasty might be avoided.

What it means for a patient

• Only 18 published cases exist worldwide, which indicates the complication is rare but also that reporting is incomplete.
• Smoking, previous nasal surgery and certain aggressive techniques were the recurring features.
• Most cases were managed without further surgery, letting the wound heal by itself.
• Because this pools case reports rather than a defined population, it cannot give a rate.

Why this paper matters

Skin loss on the nose is difficult to repair and disfiguring, and surgeons have had almost no consolidated evidence on who is at risk. This review assembles what exists. Whether the identified factors predict risk in any prospective way is untested.

Terms

• Skin necrosis: death of skin from loss of blood supply.
• Vascular compromise: reduced blood flow to tissue.
• Conservative management: treating without further surgery.
• Healing by secondary intention: allowing a wound to close on its own rather than stitching it.
• Alar base excision: removing tissue at the base of the nostril to narrow it.