Predicting Risk of Infection After Rhinoplasty with Autogenous Costal Cartilage: A Cohort Study

Prosthetic bacterial culture for bacterial identification of nasal infections after rhinoplasty

Infection following rhino-prosthesis surgery poses a significant challenge, with primary treatment strategies centered on identifying specific pathogenic bacteria through bacterial culture and administering effective antibiotics. This study aimed to investigate whether conducting bacterial cultures that specifically target the nasal prosthesis could provide more objective guidance for clinical decision-making. We included patients who developed infections subsequent to prosthesis rhinoplasty in this investigation. The clinical significance of bacterial cultures obtained from nasal prostheses was assessed by comparing the culture results with those derived from the nasal mucosa or secretions from disrupted wounds. Notably, the bacterial detection rate in samples taken from prosthetic devices was significantly higher than that observed in conventional specimens from the same patients, exhibiting a statistically significant difference. Within the prosthetic group, no statistically significant difference was identified in bacterial detection rates between patients who received antibiotics 3 days prior to surgery and those who did not. In contrast, in the conventional control group, there was a marked decrease in bacterial detection rates among patients following antibiotic administration. Among patients treated with antibiotics, the detection rate of bacteria cultured from prosthetic specimens was significantly higher compared to that in the control group; however, there were no statistical differences found regarding bacterial detection rates for those not treated with antibiotics. In analyzing materials within the prosthesis group: silicone implants showed a bacterial detection rate of 80%, expanded polytetrafluoroethylene materials had a rate of 79.2%, and other materials demonstrated a 90.9%rate. No statistically significant differences were noted among these three material types within this cohort. In contrast, within the control group: silicone implants exhibited a bacterial detection rate of 66.7%, expanded polytetrafluoroethylene materials registered at 73.6%, while other materials maintained a lower count at 63.6%. Similarly, no statistically significant differences prevailed among these groups. Culturing prosthetic specimens can enhance the detection rate of bacteria, particularly in patients who have received antibiotic therapy prior to surgery, offering distinct advantages. Therefore, we advocate for the implementation of prosthetic specimen cultures as an adjunctive measure for detecting infections post-nasal prosthesis reconstruction. Among patients treated with antibiotics, the rate of bacteria detected from cultured prosthetic specimens was significantly higher compared to that in the control group. However, no statistically significant differences were observed regarding bacterial detection rates in patients not receiving antibiotic treatment. When analyzing materials within the prosthesis group: silicone implants exhibited a bacterial detection rate of 80%, expanded polytetrafluoroethylene (ePTFE) materials had a detection rate of 79.2%, and other materials demonstrated a higher rate of 90.9%. Notably, there were no statistically significant differences among these three material types within this cohort. In contrast, within the control group: silicone implants displayed a bacterial detection rate of 66.7%, ePTFE materials showed a rate of 73.6%, while other materials recorded a lower count at 63.6%. Similarly, no statistically significant differences emerged among these groups. Culturing prosthetic specimens can enhance the detection rates of bacteria, particularly in patients who have undergone antibiotic therapy prior to surgery, thereby offering distinct advantages for infection diagnosis. Therefore, we advocate for incorporating cultures of prosthetic specimens as an adjunctive measure for detecting infections following nasal prosthesis reconstruction.Level of evidence: Level 4.

Effect of Medical Ozone Therapy in Preventing Compromised Nasal Skin in Revision Rhinoplasty

BACKGROUND

Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases.

METHODS

The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered.

RESULTS

Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted.

CONCLUSIONS

Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

BACKGROUND

Pseudomonas aeruginosa is an opportunistic pathogen, and because of its specificity, its treatments appear tricky in postrhinoplasty infections with internal implants. This study summarizes the clinical characteristics and treatment of this type of infections to provide some reference for clinical work.

METHODS

We retrospectively analyzed 10 patients who were diagnosed with a nasal infection of P. aeruginosa after implant nasal augmentation. The results of the bacterial culture and drug sensitivity test of the patients' wound secretions were summarized and analyzed. We summarized the characteristics of the patients' infection and the treatments, and we also summarized the patients' prognosis.

RESULTS

In these 10 cases, their implants included rib cartilage and ear cartilage alone, as well as their own cartilage combined with expanded polytetrafluoroethylene and silicone. All patients developed wound infections within 1 month after rhinoplasty, with bacterial cultures of P. aeruginosa . Prolonged use of sensitive antibiotics, as well as wound dressing changes, failed to keep the infection well under control. Patients whose implant was removed and thoroughly debrided within 1 week of infection did not experience any serious complications. In patients who were infected for >1 week before surgery to remove the implants, complications such as nasal column necrosis and nasal contracture occurred, and later the nasal repair was performed after multiple surgeries.

CONCLUSIONS

For bacterial infections in postrhinoplasty wounds with implants, we recommend early bacterial culture. If the infection is clearly P. aeruginosa , the implant should be removed and thoroughly debrided as soon as possible to avoid serious complications.

LEVEL OF EVIDENCE

Level IV.