Download Report

ARTICLE IN PRESS
YBJOM-3989; No. of Pages 3
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2013) xxx.e1–xxx.e3
Short communication
Management of rhinophyma with VersajetTM and ReCell®
J.A. Dunne ∗ , D.B. Saleh, J.M. Rawlins
Department of Plastic Surgery, Pinderfields Hospital, Aberford Road, Wakefield WF1 4EE, United Kingdom
Accepted 19 February 2013
Abstract
Operation is the mainstay of treatment for rhinophyma. Numerous techniques for dermaplaning and dermabrasion have been described with
typical healing times of roughly 3 weeks. We present a case that combined use of the VersajetTM (Smith & Nephew, UK) system with ReCell®
non-cultured autologous skin cells (Avita Medical, UK) to expedite re-epithelialisation. After sculpting with VersajetTM , a 1 cm2 split-thickness
skin biopsy specimen was harvested for application of autologous skin.
Postoperative pictures at 6 days show well-formed epithelial buds, and at 9 days the nose was fully healed. The application of ReCell®
hastened healing. This could potentially avoid hypertrophic scars and lessen the number of visits to outpatients for dressing to be changed,
rendering it more advantageous than other techniques.
© 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Rhinophyma; VersajetTM ; ReCell®
Introduction
Case report
Rhinophyma describes an erythematous, hypertrophied, and
tuberous enlargement of the lower half of the nose. As it
is thought to be a final manifestation of rosacea,1 medical treatments for this condition are now employed in the
management of rhinophyma.1
Regression of existing rhinophyma has not been proved
and operation is the mainstay of treatment. Electrosurgery
and laser treatment2 have been reported with good results, and
numerous techniques for dermaplaning have been described.3
Although surgical approaches can differ, the base of the
wound is dressed and typical time to healing is roughly 3
weeks or more.4 We describe use of the VersajetTM system (Smith & Nephew, UK) with ReCell® Spray-On SkinTM
(Avita Medical, UK) to hasten healing in cases of rhinophyma.
A 68-year-old warehouse worker with a history of rosacea
presented with rhinophyma of 3 years duration, which had
gradually worsened. Medical treatment with oxytetracycline
had controlled the inflammation but had had no effect on the
pre-existing rhinophyma. He did not smoke and occasionally
drank alcohol.
On examination, he had telangiectatic alar rims. The nasal
airway was patent and the rhinophyma was asymmetrical,
involving both the alar and nasal dorsum (Fig. 1). He underwent sculpting with VersajetTM and haemostasis with topical
adrenaline. A 1 cm2 split-thickness skin biopsy specimen was
harvested with a blade from the postauricular surface of the
right ear. It was processed using ReCell® and a 3 ml autologous cell suspension was produced and applied, followed by
a TelfaTM dressing (Covidien, USA) and gauze.
Postoperative pictures at 6 days show well-formed epithelial buds, and at 9 days the nose was fully healed (Fig. 2). He
required 2 visits to the plastic surgery dressing clinic before
the wound healed completely.
We advocate this method of treatment to optimise
re-epithelialisation, minimise scarring in operations for
∗
Corresponding author. Tel.: +44 7870987503.
E-mail address: Jonathan.a.dunne@gmail.com (J.A. Dunne).
0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2013.02.009
Please cite this article in press as: Dunne JA, et al. Management of rhinophyma with VersajetTM and ReCell® . Br J Oral Maxillofac Surg
(2013), http://dx.doi.org/10.1016/j.bjoms.2013.02.009
YBJOM-3989; No. of Pages 3
xxx.e2
ARTICLE IN PRESS
J.A. Dunne et al. / British Journal of Oral and Maxillofacial Surgery xxx (2013) xxx.e1–xxx.e3
Fig. 1. Preoperative picture of rhinophyma (published with the patient’s
consent).
Fig. 3. Appearance of nose 4 months after operation (published with the
patient’s consent).
rhinophyma (Fig. 3), and reduce the requirement for followup visits.
Discussion
Fig. 2. Nose fully healed 9 days after operation (published with the patient’s
consent).
Traditionally, sharp debridement of rhinophyma may result
in over-resection of tissue and may damage the delicate cartilaginous supporting structures of the nose. VersajetTM is an
additional tool that can be used to optimise sculpting of the
nasal subunits and to allow the smooth removal of tissue over
contours such as the alar and nasal dorsum.3 In the hands of
an experienced operator it is highly sensitive for the selective
removal of scarred and sebaceous tissue.
After excision of rhinophyma, patients are left with a
de-epithelialised wound that requires healing by secondary
intention and in-growth from epithelial remnants. It has the
risk of continuous bleeding, serous leaks, infection, and
delays in healing, which can result in variations in pigmentation and hypertrophic scarring.4 Healing can take up to a
month with repeated visits to the plastic surgery dressing
clinic and time off work.
In our patient, ReCell® autologous cell suspension helped
rapidly to re-epithelialise the wound, which had healed 9 days
after the procedure.
Non-cultured autologous skin cells (ReCell® ) have been
shown to be effective in re-epithelialising burns and other
Please cite this article in press as: Dunne JA, et al. Management of rhinophyma with VersajetTM and ReCell® . Br J Oral Maxillofac Surg
(2013), http://dx.doi.org/10.1016/j.bjoms.2013.02.009
YBJOM-3989; No. of Pages 3
ARTICLE IN PRESS
J.A. Dunne et al. / British Journal of Oral and Maxillofacial Surgery xxx (2013) xxx.e1–xxx.e3
trauma wounds, and it is likely that they interact with a
surgical wound in a similar manner to a burn (Rawlins J.
Non-cultured autologous skin cells (ReCell® ) in difficult
to heal chronic wounds. DeepesTissues. Official newsletter
of the Australian Wound Management Association Inc. and
the Australian and New Zealand Burns Association; June
2011:7–8).5 ReCell® has also been shown to be effective
in the elective management of patients who have revision of scars, and in disorders of pigmentation such as
vitiligo.6,7
To our knowledge this is the first report of the use of
ReCell® in the management of rhinophyma, where a good
aesthetic result after prompt healing is paramount. Methods of treatment should be compared in a single centre
where costing and time to healing with a validated aesthetic outcome can be measured accurately. Early wound
closure (with the practical advantages of fewer changes of
dressings and an earlier return to work and social activities) and a normally pigmented nose without hypertrophic
scarring is a definite advantage in the treatment of these
patients.
xxx.e3
Conﬂict of interest
None.
References
1. Rosacea RA. J Invest Dermatol 1987;88:56s–60s.
2. Greenbaum SS, Krull EA, Watnick K. Comparison of CO2 laser and
electrosurgery in the treatment of rhinophyma. J Am Acad Dermatol
1988;18:363–8.
3. Taghizadeh R, Mackay SP, Gilbert PM. Treatment of rhinophyma
with the Versajet hydrosurgery system. J Plast Reconstr Aesthet Surg
2008;61:330–3.
4. Redett RJ, Manson PN, Goldberg N, et al. Methods and results of rhinophyma treatment. Plast Reconstr Surg 2001;107:1115–23.
5. Gravante G, Di Fede MC, Araco A, et al. A randomized trial comparing
ReCell system of epidermal cells delivery versus classic skin grafts for the
treatment of deep partial thickness burns. Burns 2007;33:966–72.
6. O’Neill TB, Rawlins J, Rea S, et al. Treatment of a large congenital
melanocytic nevus with dermabrasion and autologous cell suspension
(ReCell® ): a case report. J Plast Reconstr Aesthet Surg 2011;64:1672–6.
7. Cervelli V, Spallone D, Lucarini L, et al. Treatment of stable vitiligo hands
by ReCell® system: a preliminary report. Eur Rev Med Pharmacol Sci
2010;14:691–4.
Please cite this article in press as: Dunne JA, et al. Management of rhinophyma with VersajetTM and ReCell® . Br J Oral Maxillofac Surg
(2013), http://dx.doi.org/10.1016/j.bjoms.2013.02.009