Abstract
Vascular compromise leading to cutaneous loss following surgical rhinoplasty is a
devastating complication. The objective of this review is to identify all reported
cases in literature published in English and summarize the current evidence to identify
the patients at risk of this complication following surgery. A comprehensive literature
review using Medline and Embase databases was performed to capture all reported cases
of cutaneous vascular compromise following rhinoplasty from database inception through
September 2020. Nonsurgical rhinoplasty cases were excluded. We identified eight studies
that featured vascular cutaneous compromise following surgical rhinoplasty. A total
of 18 patients were included in the analysis. The majority of the patients were females
with a mean age of 30.9. Risk factors included smoking in 23.5% patients and revision
setting. Extensive tip thinning, tight splinting and taping with dorsal onlay grafting,
or combining extended alar base excision with revision open rhinoplasty were among
surgical techniques associated with vascular compromise. The most commonly affected
aesthetic nasal subunit in our review was the dorsum followed by the nasal tip. Conservative
management primarily was utilized in 72.2% of patients, allowing the defect to heal
by secondary intention. Studies reporting on cutaneous vascular compromise following
surgical rhinoplasty are of low level of evidence. This review is the largest summary
reporting on this complication to date, aiming to caution surgeons about associated
techniques and management options. We also share an expert opinion on preoperative
assessment of nasal skin to guide surgeons to potentially avoid rhinoplasty surgery
in this subset of patients.
Keywords
rhinoplasty - skin necrosis - revision rhinoplasty
