Use of Tissue Expander for Contracted Scarred Saddle Deformity Rhinoplasty

Overview

A saddle nose with tight scarred skin cannot be rebuilt in one operation because the skin will not stretch to cover a restored framework. This single surgeon case series describes a two-stage approach that expands the skin first, using a device borrowed from reconstructive surgery.

Sections of note

• Four adult patients with saddle nose deformity and contracted soft tissue envelope; causes included vasculitis, sarcoidosis, and trauma.
• Stage one: a 1 by 4 cm tissue expander was placed along the nasal bridge through anterior scalp and internal nasal incisions.
• The expander port was positioned under the anterior scalp and injected with saline in the office over 3 weeks.
• Stage two: the expander was removed and rhinoplasty performed using osteocartilaginous rib grafts.
• All four patients had successful expansion, creating adequate space for the reconstructed framework.
• One patient had the expander become exposed through the internal nasal incision, which did not lead to any adverse outcome.
• All patients tolerated expansion well, with no reported pain or external skin breakdown.

What it means for a patient

• The skin covering is the limiting factor in rebuilding a collapsed scarred nose, and it can be stretched over three weeks before the reconstruction.
• The inflation port sits under the scalp and is filled at office visits, so this involves multiple appointments between the two operations.
• The authors present it as an alternative to bringing in skin from elsewhere on the face using a flap.
• Limits: four patients, one surgeon, no comparison group, no stated follow-up duration, and no measured outcomes.

Why this paper matters

Contracted saddle nose after vasculitis, sarcoidosis or trauma is a rare and difficult reconstruction, and the usual alternative, an interpolated flap, leaves facial scars. Tissue expansion avoids that. Four cases establish feasibility rather than effectiveness.

Terms

• Saddle nose deformity: A nose whose bridge has collapsed downward.
• Soft tissue envelope: The skin, fat and muscle covering the nasal framework.
• Tissue expander: An inflatable device implanted under skin to stretch it over time.
• Osteocartilaginous graft: A graft containing both bone and cartilage.
• Interpolated flap: Skin moved from a nearby area on a temporary pedicle to cover a defect.