Biological Spare Part Surgery Applied to Nasal Reconstruction.

Sir:

We describe an unusual case of multiple trauma in which the patient fell from a height of 20 m, sustaining panfacial fractures with severe nasoethmoid fractures and soft tissue concertina of the entire bony cartilaginous complex of the nose together with an open fracture of the right humerus complicated by segmental bone loss. The bone fragment, measuring 5 × 2.5 cm, was found in the patient’s mouth at the time of oral intubation. The orthopedic surgeons had decided to discard the bone due to contamination, and the decision was made to salvage the bone for a cantilevered bone graft for the nose. In the first stage, the bone graft was contoured and parked in a dorsal nasal pocket via an open columellar approach, at the time of external fixation of the right humerus fracture. An additional piece of bone was contoured as a columellar strut and parked between the medial crura of the lower lateral cartilages. At the second stage, the bone graft was plated to the frontonasal process at the time of upper face fracture fixation (Fig. 1). The lower lateral cartilages were plicated over the distal end of the bone graft.

Fig. 1.

Humerus bone graft precontouring.

While this surgery is well established for limb, spare-part surgery has never been applied to the injured face. This case is one of the first times the principles of biological spare-part surgery have been applied for facial reconstruction in which valuable tissue can be used in the spare-part surgery so as to maximize tissue that would otherwise be discarded. Spare-part surgery[1,2] is one which involves the reusing of tissue from nonsalvageable parts to salvage parts as it is often impossible to achieve anatomical repair for all structures after the removal of damaged tissue. To date, most examples are for extremity surgeries in which the tissue from a nonsalvageable area acts as a biological spare part to repair and recover other tissue.

Usually, in a severely traumatized nose, a cantilevered bone graft[3] is often essential to restore bony and cartilaginous support. The donor sites for the bone usually include the cranium, rib, and olecranon. All these donor sites are associated with morbidity and involve an additional operative site and increased operative duration. In such cases, the patient has sustained multiple traumas; hence, it is advantageous not to have additional trauma sites as it is important to avoid further injury and increased operative duration. As such, this surgery obviated the need to harvest future bone graft for the nasal reconstruction and thus lowered donor site morbidity.

The patient was followed up over a period of 5 years (Fig. 2) with good retention of dorsal height and tip projection. Therefore, this unique case is evidence that spare-part surgery can be performed on the face with as fulfilling results as any other body part.

Fig. 2.

Dorsal bone graft placed via open columellar incision.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article. The article processing charge was paid for by Shu Jin Lee.