Large Composite Cartilage Grafts with Hyperbaric Oxygen: An Alternative in Pediatric Facial Reconstruction
Liliana Camison, MD1, Renata Maricevich, MD1, Sanjay Naran, MD1, Alexander Davit, MD1, Oluwaseun Adetayo, MD2, Joseph E. Losee, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Albany Medical Center, Albany, NY, USA.
PURPOSE: Management of traumatic chondrocutaneous 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) for this indication remains anecdotal. We present our experience managing select pediatric defects as composite grafts with HBO.
METHODS: Four children (4-13 years-old) presented to the ED with composite facial defects secondary to dog bites or trauma. Two patients experienced subtotal ear amputations (35 and 75%). Third patient displayed a nasal defect comprising tip and both ala partially. Avulsed segments were replanted within 12 hours of ischemia following careful debridement. A fourth patient had a nasal ala avulsion, reconstructed primarily with a composite ear graft. Postoperative HBO was initiated immediately (BID/2.4 ATM) for an average of 9.5 days (range 8-10). One ear patient underwent additional leech therapy due to venous congestion.
RESULTS: Composite grafts survived with no postoperative complications. At last follow-up (range 3-14 months), patients showed satisfactory contours with minimal residual deformity and matching skin coloration. One patient had minor revisions for symmetry.
CONSLUSION: We propose an alternative for reconstruction of pediatric chondrocutaneous facial defects with immediate postoperative HBO, which would provide immediate support to the marginally perfused composite graft. This offers a good cosmetic result without the donor site morbidity of secondary reconstruction. It does not compromise surrounding tissues jeopardizing subsequent reconstructive efforts.
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