Improving outcomes for composite grafts in nasal reconstruction

Harbison, John W.; Kriet, J. David; Humphrey, Clinton D.

doi:10.1097/moo.0b013e328355b1f2

Cited by 23 publications

(31 citation statements)

References 20 publications

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“…3, [5][6][7] These studies evaluated only FTSG reconstruction, but graft loss is an even greater risk in defects reconstructed with composite (skin and cartilage) grafts. 4,8 Alterations in surgical technique and use of systemic and topical pharmacotherapy, hyperbaric oxygen, and hypothermia are techniques that improve composite graft survival, but the consequences of delaying reconstruction are still unclear. 8 We hypothesized that delaying FTSG and composite graft reconstruction is associated with decreased risk of graft necrosis and other functional complications.…”

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“…4,8 Alterations in surgical technique and use of systemic and topical pharmacotherapy, hyperbaric oxygen, and hypothermia are techniques that improve composite graft survival, but the consequences of delaying reconstruction are still unclear. 8 We hypothesized that delaying FTSG and composite graft reconstruction is associated with decreased risk of graft necrosis and other functional complications. We performed a large retrospective review using logistic regression modeling to evaluate our hypothesis.…”

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Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects

David

Miller

Park

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCEReconstructing Mohs defects often requires grafting in the form of full-thickness skin grafts (FTSGs) and composite grafts. These grafts can be complicated by a variable and often indeterminable survival rate. Other researchers have found that delaying FTSG reconstruction improves graft outcomes, but the optimal interval between excision and reconstruction remains unclear, and no study has examined the association between delaying composite graft reconstruction and graft survival.OBJECTIVE To review the outcomes of Mohs micrographic surgery defect reconstruction using FTSG and composite grafts with respect to patient-and surgery-specific variables, particularly early vs delayed reconstruction. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, single-institution cohort study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 1, 2018. No patients had to be excluded for inadequate follow-up or incomplete medical records. Delayed reconstruction was defined as greater than 6 days after Mohs excision, the third quartile of the interval to reconstruction among our cohort.MAIN OUTCOMES AND MEASURES Primary outcome was postoperative complications, including hematoma, infection, dehiscence, epidermolysis, and partial or full graft loss.RESULTS A total of 320 defects were reconstructed with FTSG or composite grafts in 310 patients (median [range] age, 68 [21-96] years; 167 female [53.9%]) during the 6-year study period. The mean interval between the ablative and reconstructive operations was 4.73 days (range, 0-35 days). Univariate logistic regression was used to determine the significant indicators among patient and defect characteristics analyzed. A multivariate logistic regression model found delayed reconstruction to have a protective association (odds ratio, 0.52; 95% CI, 0.27-0.97; P = .046) and male sex to have a harmful association (odds ratio, 2.51; 95% CI, 1.52-4.20; P < .001) with postoperative complications.CONCLUSIONS AND RELEVANCE This study found that delaying reconstruction in FTSGs and composite grafts was associated with decreased rates of postoperative complications, and male sex was associated with an increased risk of postoperative complications. The findings suggest that this strategy can be considered in patients at increased risk for developing postoperative complications, such as current smokers, patients with large defects, and patients who require use of composite grafts.LEVEL OF EVIDENCE 3.

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Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects

David

Miller

Park

et al. 2019

JAMA Facial Plast Surg

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“…Several methods have been proposed to improve survival of composite auricular grafts in nasal reconstruction, the most common being corticosteroid use, cooling, and hyperbaric oxygen therapy. One review suggests the use of a reducing dose of corticosteroids and post-operative cooling for 48–72 h to improve graft survival ( 16 ); however, there is no literature regarding the success of these methods in composite grafting of nasal tissues following traumatic injury. Further high-level evidence research is needed in this area before clear recommendations can be produced.…”

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confidence: 99%

Long-Term Outcomes of Microsurgical Nasal Replantation: Review of the Literature and Illustrated 10-Year Follow-Up of a Pediatric Case with Full Sensory Recovery

et al. 2015

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We present a case of successful artery only total nose replantation in an 18-month-old child, with 10 years of follow-up and full sensory recovery despite no nerve repair. The common absence of veins for anastomosis does not prevent successful replant, as demonstrated with the use of Hirudo medicinalis use in this unique case. We comprehensively review the literature of this rare and complex injury and advocate microsurgical replantation where possible over other methods of nasal reconstruction.

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“…They are generally used for defects less than 1 cm due to concern for viability of larger grafts, although successful use of larger grafts is described. 21,27,28 Auricular composite grafts are most commonly used for full-thickness defects of the ala, as well as for defects of the columella and at the columellarlobular junction. 21,27 While viability remains a concern for these flaps, most failures occur in tobacco users and are minimized by placing the graft in a well-vascularized recipient bed.…”

Section: Composite Graftsmentioning

confidence: 99%

Principles of Nasal Reconstruction

Spataro

Branham

2017

Facial plast Surg

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The rise in cutaneous malignancies over the past 20 years has led to significant advances in reconstructing the nose from an aesthetic and functional standpoint. The principles of nasal reconstruction center on application of the nasal subunit principle, three-layered reconstruction, nasal skin characteristics, and patient factors. Reconstructive planning starts with proper defect analysis, followed by application of the reconstructive ladder for soft-tissue repair, adequate structural support, and repair of nasal lining deficits. Optimal reconstructive methods depend on the location and size of the defect. Finally, refinement of the reconstruction is achieved through dermabrasion, scar revision, and flap thinning techniques.

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Improving outcomes for composite grafts in nasal reconstruction

Abstract: The use of corticosteroids and postoperative cooling are relatively inexpensive and effective modalities to improve auricular composite graft survival when used for nasal reconstruction. Hyperbaric oxygen therapy may have a role, but more research is needed before it is employed routinely.

Cited by 23 publications

References 20 publications

Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects

Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects

Long-Term Outcomes of Microsurgical Nasal Replantation: Review of the Literature and Illustrated 10-Year Follow-Up of a Pediatric Case with Full Sensory Recovery

Principles of Nasal Reconstruction

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