Analysis of the postoperative outcome of 81 cases of nasal reconstruction with direct closure

Abstract

Direct wound closure (side-to-side closure) for closing nasal defects, is controversially discussed. Yet, data supporting one or the other are lacking. An explorative, partly retrospective, partly prospective observational study including 81patients was carried out for assessment of the operative results of after direct wound closure stretching rhinoplasty. The occurrence of complications, the esthetic result and influencing factors were examined. To assess the esthetic result the patient and observer scar assessment scale (POSAS) scores of patients and observers were determined. In both scores seven values were determined (1point normal skin, 10points worst imaginable scar). The individual values were added to give atotal value (minimum7-maximum70). After direct wound closure stretching rhinoplasty, 12 out of 81patients (15 %) developed complications, in 5cases suture dehiscence, in 5 cases cyst formation, in 4 cases a wound infection and 2patients developed cyst formation and a wound infection. All suture dehiscences occurred on the lower third of the nose. Most of the patients were satisfied and assessed the scar with an average total value of 13.4 ± 7.07 (minimum7, maximum70, n = 42). In the individual assessments pain (1.14 ± 0.57; minimum1, maximum10) was rated best and scar color (2.50 ± 1.76; minimum1, maximum10) was rated worst. The total assessment in the observer-POSAS was also good with 12.9 ± 4.8 (minimum7, maximum70; n = 32). Elasticity was rated best (1.47 ± 0.88; minimum1, maximum7) and scar pigmentation (2.34 ± 1.54; minimum1, maximum7) worst. No correlations with acomplication were found. Direct wound closure stretching rhinoplasty is asafe method, especially for defect coverage in the upper two thirds of the soft tissue covering the nose, which in most cases achieved agood cosmetic result.