Pathophysiology
The paper highlights that vascular embolism, specifically blockage of microvessels, is a significant cause of tissue necrosis in the context of autologous fat grafting procedures [PMID:39740095].
A case report [PMID:25096650] describes necrosis affecting nearly 75% of the columella length in a baby following nCPAP ventilation in a neonatal intensive care unit.
Three patients had prior head and neck trauma or surgery, comorbidities like diabetes and hypothyroidism were present, and sensory deficits over the maxillary nerve distribution were noted [PMID:10983938].
Clinical Presentation
Three patients displayed sensory deficits related to the maxillary nerve, and two patients admitted to picking at crusted wounds [PMID:10983938].
Management
The authors emphasize that timely detection of symptoms and immediate intervention are key to successful management of vascular complications, including tissue necrosis, following fat grafting procedures [PMID:39740095].
The study [PMID:25096650] details a reconstruction technique where a neocolumella was created using mobilized nasal sill tissues, successfully addressing both functional and cosmetic impairments.
Two patients showed improvement over several months with aggressive wound care, highlighting the potential benefit of meticulous wound management [PMID:10983938].
Complications
Local skin ischemic necrosis due to blockage of nasal microvessels was observed in a case report following autologous fat grafting for augmentation rhinoplasty [PMID:39740095].
Prognosis & Follow-up
The report [PMID:25096650] highlights the long-term benefits of the described surgical technique, emphasizing its value in restoring aesthetics and function in a 21-month-old patient.
References
1 Jiang X, Cao H, He X, Zou X, Mao H, Tang L et al.. Skin necrosis after autologous fat grafting for augmentation rhinoplasty: a case report and review of the literature. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 2024. link 2 Jayaratne YS, Zwahlen RA, Htun SY, Bütow KW. Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome. BMJ case reports 2014. link 3 Rachel JD, Mathog RH. Nasal alar necrosis. The Laryngoscope 2000. link