I had a revision Rhino using ear cartilage & Alloderm. I had a crooked flat saddle nose. Within a few weeks it got infected & an abscess formed on my nose near my right eye. It was cultured & drained. I was on Bactrim Cipro & now Levaquin. The abscess is still there one month later & still draining. So now the Doctor wants to go in & remove all my grafts & the Alloderm. He wants to place my grafts behind my ears & 3 months down the line put them back. Nose is still crooked also. What do I do?
Abscess On Nose After Cartilage Graft & Alloderm. Should I Have It Removed and Repeated Later?
Doctor Answers 8
Abcess post rhinoplasty
I totally agree with the other reviewers. you need the alloderm removed. I am not sure that I would bank it in the face of infection. The viability with banking it, I am not sure that it will be in condition to use. There are other things that can be done. continued close follow up with your doctor is the best approach.
The grafts must be removed. This a dangerous place to have an infection. I will not clear up until the foreign material is removed. Saving it is another matter. I would start all over after complete healing.
Your priority is to remove the infection, then reconstruct the nose. As for the infection, since you have had multiple and very strong antibiotics, the next step is removal of the implants. The problem is that Alloderm is not a solid implant and it incorporates into the tissues, thus it is very hard to almost completely remove it.
Your doctor may be able to remove most, but not all of implant, and you may need to stay on a longer course of antibiotics, after the surgery. Once the tissues are healed a second stage can be planned for reconstruction.
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Infected implants always need removal
Obviously I do not know your case or your surgeon's reasoning, but infection around an artificial material is different than infection around your own tissues. Your body cannot clear infection around foreign materials--that is the downside to using them--especially in revisionary cases where the circulation is not normal.
The principle is to remove the implant and infected material, wait long enough (6 months or more), and then use fresh cartilage to reconstruct. Anything short of that has its risks. What is to prevent the transplanted grafts from just getting infected behind your ear? Be very careful.
It is hard to say without knowing the extent of your surgery and the abscess location/size, etc., but it would likely be beneficial to remove the AlloDerm and maybe the grafts, if they are involved in the infection. I agree they may not survive with or without banking them behind your ear but the same is true of leaving them in your nose. It does sound like your doctor is providing good follow-up and I would defer to his evaluation.
Your nasal infection after Rhinoplasty should improve after your Alloderm is removed.
I read your concern. Your physician has done everything possible to save your grafts. But a persistent abscess after Rhinoplasty with Alloderm, despite a month of antibiotics, will require removing the foreign body. Saving your cartilage behind your ear sounds reasonable, but I have no experience with that technique.
In my practice, many patients with a saddle nose deformity may be treated with Silikon-1000, an off-lable filler for permanent results.
I hope this is helpful for you.
Regards from NJ.
Nasal abscess after Alloderm rhinoplasty.
You need to have the grafts removed and it may be difficult to save the cartilage grafts behind the ear since they may get infected. You need to wait 3 months as your surgeon suggested .