The surgical treatment of rhinophyma-Complete excision and single-step reconstruction by use of a collagen-elastin matrix and an autologous non-meshed split-thickness skin graft.

INTRODUCTION: Rhinophyma is the most common clinical manifestation of phytamous rosacea. While conservative methods (e.g. topical or systemic antibiotics, retinoids) are effective for the treatment of acne rosacea, a surgical intervention is appropriate and required in established rhinophyma. A variety of surgical techniques to reduce proliferated tissue have been reported. However, a surgical "gold standard" for treating the distorting phymatous skin alterations has not yet been established. PRESENTATION OF CASE: This case report details a novel surgical approach: the combination of a bovine collagen-elastin with simultaneous autologous non-meshed split-thickness skin grafting. DISCUSSION: Our approach was based on the following considerations: deep excision facilitates complete removal of diseased tissue that ultimately reduces the risk of recurrence in contrast to commonly applied methods relying predominantly on superficial lesion removal with subsequent spontaneous re-epithelialization. The application of a dermal substitute to create a neodermis covered by split-thickness autologous skin grafting may serve as a functionally and aesthetically appropriate model without requiring the recruitment of donor sites for full-thickness skin grafts or even local flaps.
CONCLUSION: The combination of deep excision and single-step replacement of epidermal-dermal components may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome.