Compromised nasal skin in functional rhinoplasty: a literature review and proposal of a clinical management protocol.

Rhinoplasty is one of the most complex procedures in facial surgery, particularly in the context of revision surgery. The integrity of the nasal skin-soft tissue envelope (SSTE) is a critical factor for both aesthetic and functional outcomes, and vascular compromise of this structure may lead to one of the most feared complications: cutaneous necrosis. The aim of this review is to synthesize the available evidence regarding risk factors and therapeutic strategies in the management of compromised nasal skin following rhinoplasty. A literature review was conducted in PubMed and Embase to identify studies describing cutaneous necrosis following rhinoplasty surgery. The main risk factors identified were revision surgery, smoking, and aggressive thinning of the cutaneous flap. The available literature suggests that early initiation of therapies such as topical nitroglycerin, hyperbaric oxygen therapy, and pentoxifylline may improve tissue salvage in selected cases. A clinical protocol integrating preoperative assessment and an early intraoperative and postoperative management algorithm is proposed. Early identification of high-risk patients and the implementation of a standardized multimodal approach may help optimize skin viability in complex rhinoplasty procedures.