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COMPLICATIONS
In the immediate postoperative period, the potentially serious sequelae are primarily postoperative bleeding and infection. Both adverse events are rare if meticulous surgical technique is used. Nonetheless, failure to recognize either complication and intervene appropriately can lead to disastrous postoperative results. Postoperative bleeding that results in a hematoma requires immediate attention. The most effective inter-vention is an immediate return to the operating suite to remove the sutures, evacuate the hematoma, locate and ligate the bleeding vessel, and re-suture the wound. Failure to do so risks flap necrosis. If a postoperative infection is present, immediate oral antibiotics and drainage of any abscess are required.
In the mid-postoperative period, the most common complication requiring intervention is the development of a hypertrophic scar or trapdoor deformity. This usually becomes evident about 4 to 8 weeks after surgery and occasionally develops despite wide undermining, appropriate flap thinning, and meticulous suturing technique at the time of surgery. Often, the patient is advised to aggressively massage the site many times per day. Massage and tincture of time often promote adequate remodeling of the healing wound. Occasionally, active inter-vention is necessary. Varying concentrations of intralesional triamcinolone acetonide injections may be helpful (5โ40โmg/ml), depending upon the scarโs location and thickness.
Late postoperative complications include persistent trapdoor deformity, surface irregularities, blunting or ablation of the junction between cosmetic
units, and surface telangiectasia. Persistent trapdoor deformity and minor surface irregularities can be addressed as early as 6โ12 weeks postoperatively with the use of a scalpel to plane the surface and dermabrasion or dermasanding to blend the planed surface. In order to redefine the junction between cosmetic units that may have been ablated by the placement of a flap (e.g. the alar crease in a nasolabial transposition flap), incising the area, thinning the subcutis, and re-suturing the skin edges to recreate the natural fold is usually all that is required. Laser ablation of telangiectasia around the incision lines of large nasal flaps can be done for any unremitting periincisional blood vessels.
Sometimes, regardless of proper patient selection, flap planning and suturing technique, some amount of postoperative refinements may be necessary. These vary from simple procedures to correct surface irregularities to more complicated interventions requiring further scalpel surgery. The key to a successful outcome from a postoperative inter-vention is recognizing the circumstances where an intervention would be helpful and then choosing the appropriate intervention. Understanding the normal sequence of healing after a surgical procedure helps the surgeon to decide when and by what means to intervene in this process.
Nose. St. Louis: CV Mosby; 1994.12. Goldman GD. Rotation flaps. Dermatol Surg.