Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome

Abstract

Nasal continuous positive airway pressure (nCPAP) in premature babies may rarely lead to necrosis of the columella. Subsequent functional and cosmetic impairments require surgical corrections to restore nasal anatomy and architecture. The objective of this report is to document the technique of reconstruction in a baby with columella necrosis due to nCPAP treatment. A 21-month-old baby was referred to the oral and maxillofacial unit with a necrotic columella following nCPAP ventilation in a neonatal intensive care unit. Nearly 75% of the vertical columella length was affected. A neocolumella was created using tissues mobilised from the nasal sill region. This report provides a detailed description of a columella reconstruction technique which is valuable to restore aesthetics and function.

Device-related pressure ulcers: SECURE prevention

“…e incidence of PU in paediatric patients may be as high as 28%, with non-invasive mechanical ventilation associated with PU formation (relative risk ratio 12.24). 11,[19][20][21][22][23] Occurrence by type of device Regardless of setting, there is a high association between DRPU and respiratory devices. Up to 68% of DRPU are associated with respiratory devices, 9 of which 20% are linked with bilevel positive airway pressure (BiPAP) or CPAP devices, where ulceration has occurred on the bridge of the nose and/or nasolabial fold.…”

Facial Soft Tissue Injuries in Pediatric Patients

“…Several reconstructive options have been proposed to manage columellar necrosis including full-thickness skin graft, composite auricular graft and local flaps from the nose, upper lip, or cheek. [56][57][58][59][60][61][62] More complex deformities involving the soft tissue triangle or ala may incorporate these techni-ques or may require free grafts with local flaps or regional interpolated flaps from the forehead or cheek. 63 Reports indicate that more than 10% of patients treated with nCPAP developed nasal injuries that could develop as soon as 7 days after the initiation of therapy.…”

An international consensus on device-related pressure ulcers: SECURE prevention

“…Mechanical ventilation and a respiratory diagnosis are associated with higher risk of DRPU in this population . The incidence of PU in paediatric patients may be as high as 28% with non-invasive mechanical ventilation associated with PU formation (relative risk ratio 12.24) Li et al, 2015;Jayaratne et al, 2014;Newnam et al, 2015;Iwai et al, 2011;Gunlemez et al, 2010). In new-born patients, devices may severely affect and distort nasal cartilage.…”