O’Connor, Madeline J.

Background: Skin cancer patients who undergo Mohs surgery may require subsequent reconstructive rhinoplasty for large nasal defects. Autologous cartilage is the primary source of supporting cartilage grafts, but carries the risk of potential donor-site complications. In this study, we demonstrate the safety and efficacy of nonterminally irradiated fresh frozen human costal cartilage allografts (CCAs) in reconstructive rhinoplasty after skin cancer removal. Methods: A retrospective chart review of 25 patients who underwent reconstructive rhinoplasties using human CCA after basal cell carcinoma resection was conducted. Human CCA undergoes a process of sterilization without terminal irradiation and is stored frozen (−40°C to −80°C). Anthropometric measurements were taken on pre- and postoperative photographs to evaluate nasal tip projection. Adverse events were evaluated. Results: There were 25 participants, with an average age of 71 years at the time of surgery (range: 42–90). The average follow-up duration was 12 months (range: 3–66 mo). Types of grafts used included alar batten graft (n = 17, 68%), nasal tip graft (n = 7, 28%), and alar batten graft with nasal tip graft (n = 1, 4%). Measurements on the 2-dimensional photographs of the patients showed no significant resorption or deviation at the 6- or 12-month follow-up. No significant complications related to the use of the cartilage were noted. Conclusions: Our data highlight the low complication rate and aesthetically positive outcomes from using nonterminally irradiated human CCA for reconstructive rhinoplasties in post-Mohs surgery for older patients. This approach offers a reliable source of high-quality cartilage for reconstruction.

Purpose: The purpose of this article was to appraise the various methods of reconstruction for meningomyelocele (MMC) defects. Methods: A systematic review of the literature was performed to evaluate all reconstructions for MMC. The method of reconstruction was categorized by: primary closure with and without fascial flaps, random pattern flaps, VY advancement flaps (VY), perforator flaps, and myocutaneous flaps. Perforator flaps were subsequently subcategorized based on the type of flap. Results: Upon systematic review, 567 articles were screened with 104 articles assessed for eligibility. Twenty-nine articles were further reviewed and included for qualitative synthesis. Two hundred seventy patients underwent MMC repair. The lowest rates of major wound complications (MWC) were associated with myocutaneous and random pattern flaps. A majority of MWC was in the lumbrosacral/sacral region (87.5% of MWC). In this region, random patterns and perforator flaps demonstrated the lowest rate of MWC (4.5, 8.1%). Conclusions: Plastic surgery consultation should be strongly considered for MMC with defects in the lumbosacral/sacral region. Perforator flaps are excellent options for the reconstruction of these defects.