Abstract: Successful Reconstruction Of Complex Pediatric Nasal Lesions: Improving Outcomes Using A Dermal Regenerative Template in Pediatric Nasal Defects (Plastic Surgery 2013)

Saturday, October 12, 2013

Oluwaseun A. Adetayo, MD , Pediatric Plastic Surgery, University of Pittsburgh, Children’s Hospital of Pittsburgh, Pittsburgh, PA

Zoe M. MacIsaac, MD , Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, PA

Joseph E Losee, MD , Pediatric Plastic Surgery, The Children's Hosp. of Pittsburgh of UPMC, Pittsburgh, PA

Anand R. Kumar, MD , Pediatric Plastic Surgery, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Lorelei J Grunwaldt, MD , Department of Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh, Pittsburgh, PA

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ABSTRACT:

Background:

The safety and efficacy of regenerate templates combined with full thickness skin grafts (FTSG) for pediatric facial defects is not widely published. The aim of this study is to report the safety and efficacy of pediatric nasal defect reconstruction using regenerative templates/FTSG.

Methods:

A retrospective review of one institution’s pediatric nasal defects secondary to nevi or vascular lesions treated with regenerative templates was performed. All patients (n=4) were treated with a multistage protocol. Two reviewers independently assigned Visual Analogue Cosmetic Scale (VACS) scores. Standardized photographs (anteroposterior, oblique, lateral and worm’s eye view) were assigned VACS scores according to a 100 point scale: “Abhorrent”, 0-24; “Poor”, 25-49; “Moderate”, 50-74; and “Excellent”, 75-100. Statistical analysis was performed using Mann-Whitney U and Wilcoxon Paired Signed Rank tests, with significance p<0.05.

Results:

Four patients (two male and two female, average age 6.8 years) met the inclusion criteria. A total of five nasal lesions (two Spitz nevi, one vascular lesion, two congenital nevus) were removed. All patients underwent a two-stage procedure. Stage I included lesion excision and regenerative template placement. Stage II included silicone sheeting removal and FTSG placement. The average operative time per lesion was 65.5 minutes for Stage I and 93.3 minutes for Stage II. The average time between both operations was 13.8 days (range 10-19 days). The average graft area was 1.53 cm² (range 0.80-2.00 cm²). The average duration of follow up after Stage II was 175.8 days (range: 51-328 days). Complete skin graft take occurred in all patients (100%). The preoperative VACS score was 45.2 (range 5-70), compared to 84.5 (range 45-100) postoperatively (p<0.000), indicating excellent results in all patients. There were no wound infections, bleeding requiring reoperation, or mortalities.

Conclusions:

This technique is associated with low morbidity, short operative times, and high rates of skin graft survival resulting in significant improvement in Visual Analog Cosmetic scores.

22789 Successful Reconstruction Of Complex Pediatric Nasal Lesions: Improving Outcomes Using A Dermal Regenerative Template in Pediatric Nasal Defects