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

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Surgical rhinoplasty can cause devastating skin loss due to vascular compromise. This review identifies risk factors like smoking and specific surgical techniques, aiding surgeons in prevention and management.

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Area of Science:

  • Plastic Surgery
  • Otolaryngology
  • Dermatology

Background:

  • Cutaneous vascular compromise is a severe complication of surgical rhinoplasty.
  • Identifying at-risk patients and associated surgical techniques is crucial for prevention.

Purpose of the Study:

  • To review and summarize all reported cases of cutaneous vascular compromise following surgical rhinoplasty.
  • To identify patient risk factors and surgical techniques associated with this complication.

Main Methods:

  • Comprehensive literature review of Medline and Embase databases (inception–September 2020).
  • Inclusion of English-language studies reporting vascular cutaneous compromise after surgical rhinoplasty.
  • Exclusion of nonsurgical rhinoplasty cases.

Main Results:

  • Eight studies with 18 patients were analyzed; most were female (mean age 30.9).
  • Risk factors included smoking (23.5%) and revision surgery.
  • Associated techniques: extensive tip thinning, tight splinting/taping with dorsal onlay grafts, extended alar base excision with revision open rhinoplasty.
  • Most affected areas: nasal dorsum and tip.
  • Conservative management (secondary intention healing) used in 72.2% of cases.

Conclusions:

  • Surgical techniques and patient factors like smoking increase the risk of cutaneous vascular compromise in rhinoplasty.
  • Conservative management is often effective.
  • Preoperative assessment of nasal skin may help identify patients who could benefit from avoiding surgery.