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Columellar Reconstruction following Nasal Continuous Positive Airway Pressure Injury

Chang, Catherine S. M.D.; Swanson, Jordan W. M.D., M.Sc.; Wilson, Anthony M.D.; Low, David W. M.D.; Bartlett, Scott P. M.D.

Plastic and Reconstructive Surgery: January 2018 - Volume 141 - Issue 1 - p 99e-102e
doi: 10.1097/PRS.0000000000003978
Reconstructive: Head and Neck: Ideas and Innovations

Summary: Nasal continuous positive airway pressure is used increasingly to treat pulmonary immaturity in premature neonates. Nasal injury is common with nasal continuous positive airway pressure use, with full-thickness tissue loss at the columella among the most devastating complications. Columellar necrosis often imparts a full-thickness injury to the overlying columellar skin, the medial crura of the lower lateral nasal cartilages, the anteromedial inner nasal mucosal lining, and potentially the anterior septal cartilage. Consequently, the columella can become scarred and shortened. Although multiple techniques have been described to reconstruct the columella, no known technique has been specifically developed to treat the unique columellar defect common to severe nasal continuous positive airway pressure injury. Donor-site morbidity related to these techniques, and how growth of the reconstructed nose will proceed, are obvious concerns, especially in young children. The authors present a novel reconstruction technique that uses recreation of the defect with posteriorly based book flaps and auricular chondrocutaneous composite graft interposition. This technique has several advantages, including avoiding central facial scars, supplying well-matched skin color and texture, and facilitating robust tip support. The authors retrospectively review the use and outcomes of this technique from 1995 and 2016 on all patients with a history of nasal continuous positive airway pressure columellar necrosis at their center.

Philadelphia, Pa.

From the Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania; and the Division of Plastic Surgery, Children’s Hospital of Philadelphia.

Received for publication February 21, 2017; accepted July 18, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received.

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Catherine S. Chang, M.D., Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, South Tower, 7th Floor, Philadelphia, Pa. 19104,

Copyright © 2017 by the American Society of Plastic Surgeons