“The Use of Biologic Agents in Nasal Reconstruction: A Review of 138 Cases”

Background: Reconstruction of nasal defects can prove challenging for plastic surgeons, requiring consideration of both aesthetics and function. While many reconstructive techniques exist, the study of biologic agents in nasal reconstruction remains limited. Methods: We conducted a retrospective review of patients who underwent nasal reconstruction using a biologic wound healing agent (Integra or ACell) from 2013 to 2023 performed by the senior author (J.F.T.). Data was collected and analyzed regarding patient demographics, defect characteristics, reconstructive modality, revisions, and complications. Results: A total of 138 patients underwent nasal reconstruction using Integra or ACell. The ala was the most commonly affected subunit (25.4 percent), and the mean defect size was 6.9 cm 2 . ACell was the most common biologic used for reconstruction (73.2 percent). The overall complication rate was 6.5 percent (n = 9), ranging from scar retraction to biologic loss. There were no statistically significant differences in complication rates among patients over 75 years of age, those with a history of cigarette smoking, or those on anticoagulation. Additionally, defect size and location did not significantly impact complication rates. Conclusions: Nasal reconstruction requires consideration of numerous patient and defect variables. Compared to a multi-staged reconstructive procedure, biologic agents offer a simpler, well-tolerated, and effective alternative. This study supports the reliability of biologic agents in nasal reconstruction, including in high-risk populations such as elderly patients, smokers, and those on anticoagulation therapy.