Nasal Cutaneous Fistula (Non-Healing Wound): A Rare Complication of Rhinoplasty

Skin Fistula After Nose Aesthetic Operation

Skin Fistula After Rhinoplasty - Revision Noe Tip Plasty - Fistula Removal From Nasal Skin

In the photo above and in the video below, we see a patient who had undergone 2 aesthetic nasal surgeries and started after the last operation and had inflammatory discharge from the nasal skin. Inflammatory discharge was present for more than 6 months and the PDS stitche material was removed with discharge. It is stated that the discharge from the skin is less and less frequent in the following period. The patient was referred to us for the treatment of the resulting skin fistula and chronic asymptomatic skin discharge. There was a fistula tract between the discharge area and the intranasal vestibular mucosa. The ellipsoid skin and the fistula tract were removed and the cartilage graft obtained from the nasal septum subcutaneously was spread. Absorbable stitche materials were sutured. In the operation performed as open technique nasal tip aesthetics, cartilage grafts were placed between the columella and the inner crus of the alar cartilages and columellar retraction treatment was provided.

Skin Reaction of Polydioxanone Suture (PDS) Material

Polydioxanone suture (PDS sutures) is a sterile monofilament synthetic absorbable suture materials and it absorbed in 6 months, is commonly used for nasal tip aesthetic surgeries and rhinoplasty operations. Skin reaction risks of this suture material is very rare and the complication rate is extremely low compared to other non-absorbable suture materials. There is a similar case report was published about Polydioxanone suture skin reaction at >> Early Skin Reaction of Polydioxanone Suture Material Following Septorhinoplasty

Skin reactions due to non-absorbable suture materials

In particular, skin reactions due to non-absorbable suture materials were observed, and this was due to the commonly used PDS suture material in the patient. When I spoke with my friend in detail, the non-absorbable suture, including "Prolene", was not used in that area. The suture material coming out of the patient's nasal skin was found to be compatible with PDS. In the last procedure, no suture material was observed at the edge of the nest. In rare cases, these complications may cause stress and distress for patients and may adversely affect the outcome. It should be kept in mind that, although very rare, each surgery carries its own risks and no operation can be risk-free. It is best to avoid using non-absorbable suture material as often as possible during the rhinoplasty operation. I wish you success in your surgery.

Non-healing wound on nose skin (suture material reaction)

Today, we use almost always different sutures in aesthetic nose surgeries. Only when the skin is sutured, we call the prolene non-melting stitches can be preferred. I don't buy stitches because I use melted yarns in my own patients. However, rarely, surgeons can use prolene (non absorbable sutures) when suturing cartilage within the nose. Especially in the old years, prolene was used in almost all operations. Today, however, the rate of prolene use is very low. Non-absorbable suture materials, which are able to apply more firm and stronger pressures, often cause foreign body reactions and non-healing wounds on the skin.

Due to non-absorbable sutures, the following problems sometimes arise:

foreign body reactions
recurrent subcutaneous infections
skin color changes
skin openings and stitching out of the skin
there are areas of roughness or collapse of the skin surface

Is it a doctor's fault to use sutures?

No it is not. Many surgeons use prolene in many patients. However, a very very rare patient develops a reaction.

Is there any scarring where the inflammation flows after surgery?

As skin integrity deteriorates, there will always be some scarring. This defective site should be repaired during surgery.

In case of a non-healing wound and suture reaction, is it appropriate to remove it by external incision or subcutaneously?

The incisions made on the nose skin usually heal by leaving a scar. I recommend taking an internal incision. suture reaction and / or infection can sometimes be seen in molten sutures. long-lasting and non-healing tissue response needs to be sutured.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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