Revision surgery after removal of infected Gore-Tex implant and ear cartilage for the tip.

Question

Good day Doctor. I had my rhinoplasty with gore tex implant on my nose bridge and ear cartilage on my tip with alar trimming last February of 2014. Just recently, 5 days ago to be exact, I had it removed because it was infected. I just would like to ask if how long should I wait before a possible reconstruction either with rib or ear cartilage.. Thank you.

William Portuese, MD · Answer

Its probably best to wait at least a year before undergoing a revision rhinoplasty procedure to allow all of the infection to be resolved and the extensive healing process from both surgeries within a week of each other.

Tom D. Wang, MD, FACS · Answer

Hi there, in my experience, once the Goretex is removed, the infection tends to resolve fairly quickly.  Assuming no further infection, reconstruction may take place as early as 3 months later.  Of course, we have had good experience with immediate reconstruction using homologous rib cartilage even in the setting of infected implants and this has been published in the literature.  Best of luck to you!

Robert J. Troell, MD, FACS - Account Suspended · Answer

Good Day. Excellent question on timing of reconstruction after removing an infected synthetic graft.First, ensure that the infection is adequately treated. Once the synthetic material (gore-tex) is removed and any tissue with lack of blood supply (avascular) is removed (debrided) oral antibiotic therapy is begun.It s best to culture the removed tissue to determine the most appropriate antibiotic to resolve the current acute infection. The antibiotic duration is dependent on your response, typically 10-14 days. You may require more than one antibiotic if there are multiple types of bacteria present or if the bacteria are MRSA (methicillin resistant staphylococcus bureau) or Pseudomonas.There is some controversy in timing, however, I recommend being more conservative and allow the infection to be completely resolved and the body to heal the inflamed tissues. The infection and acute inflammation most likely will take 4-6 weeks to resolve. I would wait 4-6 months for healing, while continuing to observe the skin envelope of the nose for excess scarring and shrinkage.If you go in too soon for reconstruction, this complex procedure may also become compromised. Rib cartilage and the firm tissue above your temporal area, known as the temporals fascia, is most likely the best option for nasal dorsal augmentation. Surgical reconstruction entails cutting the rib cartilage into minute pieces and placing this cartilage slivers inside the fascia like a "hot dog in a bun". The nasal tip  should be reconstructed by preferably using your nasal septal cartilage or secondarily your ear (conchal) cartilage.In summary, ensure the antibiotics is the correct one associated with your bacterial culture, the duration of antibiotic treatment completely resolves the infection, allow a minimum of 4-6 months for inflammation resolution (unless unsatisfactory skin envelope scarring occurs) and choose a competent surgery to reconstruct the nose using your own tissue (no synthetic material).Please be patient, you will be glad you waited.

Revision surgery after removal of infected Gore-Tex implant and ear cartilage for the tip.

Answers (3)

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