Skip to main content
Top
Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Hyperpigmentation | Research

Single-stage acellular dermal matrix reconstruction of defects in the nose and ears with exposed cartilage: a prospective case series

Authors: Yung-Hsu Lei, Shu-Hung Huang

Published in: BMC Surgery | Issue 1/2022

Login to get access

Abstract

Background

The treatment of soft tissue defects with exposed cartilage after tumor excision is challenging. Local flap reconstruction causes occasional scarring, especially in non-Caucasian populations. Scar treatment requires secondary procedures for aesthetic modifications. Two-step reconstruction with an acellular dermal matrix addresses this issue and yields highly acceptable aesthetic resultsWe aimed to investigate the efficacy of an artificial dermal matrix cover using one-step reconstruction for defects with cartilage exposure.

Methods

From July 2018 to September 2020, seven patients were enrolled and underwent a single-stage operation using acellular dermal matrices. Patients were followed up for at least 6 months and the size of the wound, days to heal, patient satisfaction, and scar scale scores were recorded.

Results

Patients were followed up for an average of 25.7 months. The average time to heal was 23.4 days postoperatively. No hyperpigmentation, tumor recurrence, or retraction was noted. High acceptance and satisfaction with the outcome were observed in all patients.

Conclusions

Single-stage reconstruction yielded high acceptance of aesthetic results similar to that in two-stage reconstruction. Less time and cost make this an effective and efficient treatment for soft tissue defects compared with traditional techniques.
Literature
1.
go back to reference Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg. 2013;27:96–103.CrossRef Correa BJ, Weathers WM, Wolfswinkel EM, Thornton JF. The forehead flap: the gold standard of nasal soft tissue reconstruction. Semin Plast Surg. 2013;27:96–103.CrossRef
2.
go back to reference Daya M, Anderson I, Troyer M, Portnof J. Two step reconstruction of traumatic ear skin avulsion using Integra graft. J Stomatol Oral Maxillofac Surg. 2018;119:294–6.CrossRef Daya M, Anderson I, Troyer M, Portnof J. Two step reconstruction of traumatic ear skin avulsion using Integra graft. J Stomatol Oral Maxillofac Surg. 2018;119:294–6.CrossRef
3.
go back to reference Rogers-Vizena CR, Lalonde DH, Menick FJ, Bentz ML. Surgical treatment and reconstruction of nonmelanoma facial skin cancers. Plast Reconstr Surg. 2015;135:895e–908e.CrossRef Rogers-Vizena CR, Lalonde DH, Menick FJ, Bentz ML. Surgical treatment and reconstruction of nonmelanoma facial skin cancers. Plast Reconstr Surg. 2015;135:895e–908e.CrossRef
4.
go back to reference van der Eerden P, Simmons M, Vuyk H. Reconstruction of nasal sidewall defects after excision of nonmelanoma skin cancer: analysis of uncovered subcutaneous hinge flaps allowed to heal by secondary intention. Arch Facial Plast Surg. 2008;10:131–6.CrossRef van der Eerden P, Simmons M, Vuyk H. Reconstruction of nasal sidewall defects after excision of nonmelanoma skin cancer: analysis of uncovered subcutaneous hinge flaps allowed to heal by secondary intention. Arch Facial Plast Surg. 2008;10:131–6.CrossRef
5.
go back to reference Schäfer K, Rudolph C, Cotofana S, Goebeler M, Weyandt G. Large nasal defects with exposed cartilage: the folded transposition flap as an innovative alternative to the paramedian forehead flap. Dermatology. 2018;234:99–104.CrossRef Schäfer K, Rudolph C, Cotofana S, Goebeler M, Weyandt G. Large nasal defects with exposed cartilage: the folded transposition flap as an innovative alternative to the paramedian forehead flap. Dermatology. 2018;234:99–104.CrossRef
6.
go back to reference Seth AK, Ratanshi I, Dayan JH, Disa JJ, Mehrara BJ. Nasal reconstruction using the integra dermal regeneration template. Plast Reconstr Surg. 2019;144:966–70.CrossRef Seth AK, Ratanshi I, Dayan JH, Disa JJ, Mehrara BJ. Nasal reconstruction using the integra dermal regeneration template. Plast Reconstr Surg. 2019;144:966–70.CrossRef
7.
go back to reference Cavaliere A, Maisto B, Zaporojan T, Giordano L, Sorbino L, Zaffiro A, et al. Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results. JPRAS Open. 2021;29:82–8.CrossRef Cavaliere A, Maisto B, Zaporojan T, Giordano L, Sorbino L, Zaffiro A, et al. Extended rotation flap for reconstruction of partial thickness defects of the tip and nasal ala region: in search of better aesthetic results. JPRAS Open. 2021;29:82–8.CrossRef
8.
go back to reference Losco L, Bolletta A, Pierazzi DM, Spadoni D, Cuomo R, Marcasciano M, et al. Reconstruction of the nose: management of nasal cutaneous defects according to aesthetic subunit and defect size a review. Medicina (Kaunas). 2020;56:639.CrossRef Losco L, Bolletta A, Pierazzi DM, Spadoni D, Cuomo R, Marcasciano M, et al. Reconstruction of the nose: management of nasal cutaneous defects according to aesthetic subunit and defect size a review. Medicina (Kaunas). 2020;56:639.CrossRef
9.
go back to reference Schonauer F, Vuppalapati G, Marlino S, Santorelli A, Canta L, Molea G. Versatility of the posterior auricular flap in partial ear reconstruction. Plast Reconstr Surg. 2010;126:1213–21.CrossRef Schonauer F, Vuppalapati G, Marlino S, Santorelli A, Canta L, Molea G. Versatility of the posterior auricular flap in partial ear reconstruction. Plast Reconstr Surg. 2010;126:1213–21.CrossRef
10.
go back to reference Koh IS, Sun H. A practical approach to nasal reconstruction in Asian patients. Arch Craniofac Surg. 2021;22:268–75.CrossRef Koh IS, Sun H. A practical approach to nasal reconstruction in Asian patients. Arch Craniofac Surg. 2021;22:268–75.CrossRef
11.
go back to reference Jin HR, Jeong WJ. Reconstruction of nasal cutaneous defects in Asians. Auris Nasus Larynx. 2009;36:560–6.CrossRef Jin HR, Jeong WJ. Reconstruction of nasal cutaneous defects in Asians. Auris Nasus Larynx. 2009;36:560–6.CrossRef
12.
go back to reference Cerci FB, Dellatorre G. Paramedian forehead flap combined with hinge flap for nasal tip reconstruction. An Bras Dermatol. 2016;91:140–3.CrossRef Cerci FB, Dellatorre G. Paramedian forehead flap combined with hinge flap for nasal tip reconstruction. An Bras Dermatol. 2016;91:140–3.CrossRef
13.
go back to reference Choi JH, Yoo H, Kim BJ. Nasal alar rim redraping method to prevent alar retraction in rhinoplasty for Asian men: a retrospective case series. Arch Plast Surg. 2021;48:3–9.CrossRef Choi JH, Yoo H, Kim BJ. Nasal alar rim redraping method to prevent alar retraction in rhinoplasty for Asian men: a retrospective case series. Arch Plast Surg. 2021;48:3–9.CrossRef
14.
go back to reference Burd A, Wong PS. One-stage Integra reconstruction in head and neck defects. J Plast Reconstr Aesthet Surg. 2010;63:404–9.CrossRef Burd A, Wong PS. One-stage Integra reconstruction in head and neck defects. J Plast Reconstr Aesthet Surg. 2010;63:404–9.CrossRef
15.
go back to reference Noda Y, Kuwahara H, Morimoto M, Ogawa R. Reconstruction of anterior neck scar contracture using a perforator-supercharged transposition Flap. Plast Reconstr Surg Glob Open. 2018;6: e1485.CrossRef Noda Y, Kuwahara H, Morimoto M, Ogawa R. Reconstruction of anterior neck scar contracture using a perforator-supercharged transposition Flap. Plast Reconstr Surg Glob Open. 2018;6: e1485.CrossRef
16.
go back to reference Bolletta A, Losco L, Pozzi M, Schettino M, Cigna E. A retrospective study on single-stage reconstruction of the ear following skin cancer excision in elderly patients. J Clin Med. 2022;11:838.CrossRef Bolletta A, Losco L, Pozzi M, Schettino M, Cigna E. A retrospective study on single-stage reconstruction of the ear following skin cancer excision in elderly patients. J Clin Med. 2022;11:838.CrossRef
17.
go back to reference Applebaum MA, Daggett JD, Carter WL. Nasal tip reconstruction using integra bilayer wound matrix: an alternative to the forehead flap. Eplasty. 2015;15: e52. Applebaum MA, Daggett JD, Carter WL. Nasal tip reconstruction using integra bilayer wound matrix: an alternative to the forehead flap. Eplasty. 2015;15: e52.
18.
go back to reference Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16:535–8.CrossRef Baryza MJ, Baryza GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16:535–8.CrossRef
19.
go back to reference Suzuki S, Matsuda K, Maruguchi T, Nishimura Y, Ikada Y. Further applications of “bilayer artificial skin.” Br J Plast Surg. 1995;48:222–9.CrossRef Suzuki S, Matsuda K, Maruguchi T, Nishimura Y, Ikada Y. Further applications of “bilayer artificial skin.” Br J Plast Surg. 1995;48:222–9.CrossRef
20.
go back to reference Kashimura T, Nagasaki K, Horigome M, Yoshida K, Soejima K. Selection of artificial dermis for shortening treatment period: Integra versus Pelnac. Plast Reconstr Surg Glob Open. 2021;9: e3599.CrossRef Kashimura T, Nagasaki K, Horigome M, Yoshida K, Soejima K. Selection of artificial dermis for shortening treatment period: Integra versus Pelnac. Plast Reconstr Surg Glob Open. 2021;9: e3599.CrossRef
21.
go back to reference Tiengo C, Amabile A, Azzena B. The contribution of a dermal substitute in the three-layers reconstruction of a nose tip avulsion. J Plast Reconstr Aesthet Surg. 2012;65:114–7.CrossRef Tiengo C, Amabile A, Azzena B. The contribution of a dermal substitute in the three-layers reconstruction of a nose tip avulsion. J Plast Reconstr Aesthet Surg. 2012;65:114–7.CrossRef
22.
go back to reference Johnson EL, Danilkovitch A. Nonsurgical management of a large necrotic nasal tip wound using a viable cryopreserved placental membrane. Clin Case Rep. 2018;6:2163–7.CrossRef Johnson EL, Danilkovitch A. Nonsurgical management of a large necrotic nasal tip wound using a viable cryopreserved placental membrane. Clin Case Rep. 2018;6:2163–7.CrossRef
23.
go back to reference Calloway HE, Moubayed SP, Most SP. Cost-effectiveness of early division of the forehead flap pedicle. JAMA Facial Plast Surg. 2017;19:418–20.CrossRef Calloway HE, Moubayed SP, Most SP. Cost-effectiveness of early division of the forehead flap pedicle. JAMA Facial Plast Surg. 2017;19:418–20.CrossRef
24.
go back to reference Torresetti M, Scalise A, Di Benedetto G. Acellular dermal matrix for rhinophyma: is it worth it? A new case report and review of literature. Int J Surg Case Rep. 2019;59:120–3.CrossRef Torresetti M, Scalise A, Di Benedetto G. Acellular dermal matrix for rhinophyma: is it worth it? A new case report and review of literature. Int J Surg Case Rep. 2019;59:120–3.CrossRef
25.
go back to reference Lee LF, Porch JV, Spenler W, Garner WL. Integra in lower extremity reconstruction after burn injury. Plast Reconstr Surg. 2018;121:1256–62.CrossRef Lee LF, Porch JV, Spenler W, Garner WL. Integra in lower extremity reconstruction after burn injury. Plast Reconstr Surg. 2018;121:1256–62.CrossRef
26.
go back to reference Schiavon M, Francescon M, Drigo D, Salloum G, Baraziol R, Tesei J, et al. The use of integra dermal regeneration template versus flaps for reconstruction of full-thickness scalp defects involving the calvaria: a cost-benefit analysis. Aesthetic Plast Surg. 2016;40:901–7.CrossRef Schiavon M, Francescon M, Drigo D, Salloum G, Baraziol R, Tesei J, et al. The use of integra dermal regeneration template versus flaps for reconstruction of full-thickness scalp defects involving the calvaria: a cost-benefit analysis. Aesthetic Plast Surg. 2016;40:901–7.CrossRef
Metadata
Title
Single-stage acellular dermal matrix reconstruction of defects in the nose and ears with exposed cartilage: a prospective case series
Authors
Yung-Hsu Lei
Shu-Hung Huang
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01859-7

Other articles of this Issue 1/2022

BMC Surgery 1/2022 Go to the issue