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Large Composite Cartilage Grafts with Hyperbaric Oxygen: An Alternative in Pediatric Facial Reconstruction
Liliana Camison, M.D., Sanjay Naran, M.D., Renata S. Maricevich, M.D., Jesse A. Goldstein, M.D., Alexander J. Davit III, M.D., Lorelei J. Grunwaldt, M.D., Oluwaseun Adetayo, M.D., Joseph E. Losee, M.D
University of Pittsburgh, Department of Plastic Surgery
2015-03-15
Presenter: Liliana Camison, MD
Affidavit:
I agree with all information and authorship in this abstract. This is original data and has not been published.
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: Management of traumatic composite facial defects in children is challenging. Microvascular reconstruction is not always feasible, and replantation of large composite grafts is usually unsuccessful. Hyperbaric oxygen therapy (HBO) has been researched to augment graft survival, but clinical use remains anecdotal. We present our successful experience managing select facial defects as composite grafts with HBO.
METHODS: A retrospective chart review was performed to identify pediatric patients presenting between 2008-2014 with composite chondrocutaneous facial defects, managed operatively with additional HBO. Their records were reviewed for all operative, pre and post-operative data to assess success.
RESULTS: Seven children (average 7.8 years; 1.6-14) presented with composite facial defects secondary to dog bites (n=6) or falls (n=1). Two patients experienced ear amputations (35 or 75% of the pinna). Five had complex composite nasal avulsions involving at least 3 aesthetic subunits. The large grafts were replanted when available (n=5). Otherwise, primary reconstruction with composite ear grafts was performed (n=2).
HBO was initiated immediately (BID; 2.4 ATM) for 9.5 days (8-10). One patient underwent additional leech therapy.
All grafts survived without complications. At last follow-up (average 16.25 months; 1.6-30), all patients showed satisfactory contours, minimal deformity and matching coloration. One nasal defect required fat grafting to improve alar symmetry.
CONSLUSION: We propose a non-microvascular alternative for reconstruction of complex composite facial defects in children using HBO. This would provide immediate support to the marginally perfused composite graft, while offering a good cosmetic result and sparing the donor site morbidity of a secondary reconstruction.
