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.
