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Pascali M, Gratteri M, Savani L, Rega U, Marchese G, Persichetti P. Fresh Frozen, In-Alcohol, or Autologous Costal Cartilage? Analysis of Complications in Over 650 Revision Rhinoplasties. Aesthet Surg J 2024; 44:897-908. [PMID: 38428952 DOI: 10.1093/asj/sjae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND When there is insufficient autologous septal cartilage for graft sculpting in revision rhinoplasty, valid alternatives need to be found. Both autologous and homologous costal cartilage usage has been described in the literature. As there is no universally accepted consensus on cartilage choice, experience with different types of cartilage assumes significant importance in the rhinoplasty learning process. OBJECTIVES This multicenter prospective study outlined an overview of the authors' experience regarding short-term and long-term complications following revision rhinoplasty procedures in which either fresh frozen (FFCC), in-alcohol (IACC), or autologous costal cartilage (ACC) was used. METHODS A total of 671 patients undergoing revision rhinoplasty between June 2015 and September 2020 were divided into 3 groups according to the type of cartilage used (Group 1, 212 patients with FFCC; Group 2, 239 patients with IACC; Group 3, 202 patients with ACC). Sociodemographic and clinical characteristics and short- and long-term complications were described and discussed. A statistical analysis investigating a possible significance of the differences in complication rates was conducted. RESULTS The data obtained indicated a short-term general complication rate of 5.05%, and a long-term complication rate of 7.04%. A statistically significant difference was identified in cartilage warping rate between the homologous cartilages in comparison to ACC. CONCLUSIONS FFCC, IACC, and ACC can be safely used in revision rhinoplasty with no statistically significant differences regarding short- and long-term complication rates. Cartilage warping rate is significantly higher for ACC compared with FFCC and IACC. LEVEL OF EVIDENCE: 2
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Jin C, Wu Q, Yin A, Chen J, Liu H, Mu S, Zhang X. Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty. Aesthetic Plast Surg 2024; 48:2404-2411. [PMID: 38233685 DOI: 10.1007/s00266-023-03799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head. METHODS A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment. RESULTS A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported. CONCLUSION The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Changxin Jin
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China
| | - Qiong Wu
- Department of Medical cosmetology, The First Hospital of Xi'an, Xi'an, Shaanxi, China
- Provincial Key Laboratory of Biotechnology of Shaanxi, Key Laboratory of Resource Biology and Modern Biotechnology in Western China, Faculty of Life Science, Northwest University, Xi'an, 710032, Shaanxi, China
| | - Anan Yin
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China.
| | - Jie Chen
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China
| | - Hengxin Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China
| | - Siqi Mu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China
| | - Xi Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Medical University, Changle West Road, No. 169, Xi'an, 710032, Shaanxi, China.
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Zhang Z, Wu J, Yu Z, Zhang Y, Zhang J, Song B. Novel "Z" Technique to Overcome Warping of Costal Cartilage. Aesthet Surg J 2023; 44:20-25. [PMID: 37540898 DOI: 10.1093/asj/sjad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Dorsal augmentation with costal cartilage is generally used for aesthetic rhinoplasty. However, the tendency of costal cartilage to warp may jeopardize the aesthetic outcome. OBJECTIVES The aim of this study was to describe a new "Z" technique to overcome the warping of costal cartilage after implantation and to evaluate the efficacy of this technique in vitro. METHODS A total of 31 pairs of porcine costal cartilage grafts (40 mm × 10 mm × 5 mm) were obtained and kept in Dulbecco's Modified Eagle Medium (Sigma-Aldrich, St. Louis, MO) to maintain cell viability. Paired grafts were obtained and randomly allocated for preparation by the accordion technique and the "Z" technique. Standardized photographs (obtained immediately after operation and at 4 weeks) were used for warping analysis. Biomechanical testing was performed to measure the graft's capacity to resist deformation by an external force. RESULTS Cell viability of the grafts at 4 weeks was comparably good in the accordion group and the Z group (61.88% ± 4.47% vs 67.48% ± 7.03%, P = 0.55). Warping angle was comparable between the 2 groups (P > 0.01). The capacity to resist external force was significantly better in the Z group; the force needed to cause deformation was 3.98 ± 1.04 N in the Z group vs 1.61 ± 0.47 N in the accordion group in lateral view (P < 0.0001), and 1.33 ± 0.41 N vs 0.96 ± 0.24 N, respectively, in frontal view (P = 0.0013). CONCLUSIONS The "Z" technique appears to be a simple and effective method to minimize the tendency of costal cartilage to warp after implantation.
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Laverty RB, Morris E, Brooks DI, Hohman MH, Teixeira J. Biochemical Compositional Analysis of Cadaveric Rib Cartilage. Facial Plast Surg Aesthet Med 2023; 25:44-48. [PMID: 34860118 DOI: 10.1089/fpsam.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Cadaveric rib is used as a cartilage source for reconstructive rhinoplasty in patients who lack sufficient native septal cartilage; however, these grafts are known to warp. Objective: To measure and compare the biochemical properties of cadaveric rib as related to age, gender, and cortical versus core location. Methods: Seven cadaveric rib cartilage specimens were obtained and sectioned into cortical and core segments. Biochemical assays were used to determine total collagen and sulfated glycosaminoglycan (sGAG) content. Results: Collagen was present in higher amounts in cortical segments than core samples (72.8 ± 35.14 vs. 37.3 ± 16.99 μg/mgww, p = 0.0005). sGAG was also shown to be more prevalent in cortical segments (25.47 ± 11.59 vs. 12.17 ± 7.15 μg/mgww, p < 0.0001). The concentrations of collagen and sGAG demonstrated a positive correlation (R2 = 0.44, p = 0.0004). Collagen and sGAG content decreased with the age of the donor (p = 0.001 and p < 0.0001, respectively), but donor gender did not appear to affect collagen or sGAG content (p = 0.62 and p = 0.43, respectively). Conclusion: Collagen and sGAG content was higher in cortical segments of cadaveric rib cartilage than in core segments, and higher in samples from younger cadavers as well.
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Affiliation(s)
- Robert B Laverty
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, USA
| | - Elena Morris
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Marc H Hohman
- Department of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Jeffrey Teixeira
- Department of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington, USA
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Abstract
PURPOSE OF REVIEW The role of perichondrium in cartilage graft survival has been long debated. Although the innate function of perichondrium in providing mechanical and regenerative support to cartilage in its native position is relatively undisputed, studies continue to vacillate over how the perichondrium effects cartilage grafts once transplanted. This review evaluates historical and recent experiments showing how perichondrium may or may not impact graft survival. RECENT FINDINGS Experimental studies in animal models have more recently evaluated macroscopic and microscopic properties of diced cartilage grafts with and without perichondrium, finding that in general grafted cartilage with perichondrial components retains greater weight and mechanical strength compared with cartilage without perichondrial components. However, these findings have not been replicated in humans. Solid pieces of rib cartilage have most recently been used without perichondrium to prevent warping, though no studies have evaluated whether retaining perichondrium with oblique and concentric cutting techniques may effect overall resorption. SUMMARY Although historical opinions and more recent animal studies suggest a role of perichondrium in cartilage graft survival, randomized controlled human studies are still lacking on whether retaining perichondrium truly effects graft survival and ultimate surgical outcomes.
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Successful Repair of a Forehead Depression Deformation due to En Coup de Sabre using Costal Cartilage Transplantation. J Craniofac Surg 2022; 33:e585-e586. [DOI: 10.1097/scs.0000000000008583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
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Harvesting Split Costal Cartilage Graft in Revision Rhinoplasty Without Disturbing the Costal Integrity. Aesthetic Plast Surg 2021; 45:1191-1196. [PMID: 33432390 DOI: 10.1007/s00266-020-02108-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Graft use is inevitable in some primary and secondary rhinoplasty cases with cartilage or bone deficiency. Although rib graft is one of the best graft sources, it has several disadvantages. The purpose of this study is to minimize the risks of using rib grafts. MATERIAL AND METHODS Between 2018 and 2020, a total of 21 patients aged between 25 and 55 have undergone revision rhinoplasty under general anesthesia with a split cartilage graft of central origin. A 3-4-mm-thick bridge was left at the superior and inferior edges of the donor area, and the graft was harvested from the central region without disrupting the costal integrity. A special retractor was placed between the perichondrium and the rib at the posterior of the costa to prevent damage to the pleura while cutting the rib. The previously marked grafts were cut in the donor area and harvested ready for use. The harvested grafts were used as spreader, strut, alar rim and nasal valve grafts. RESULTS None of the patients had complications due to rib graft harvesting. After the operation, pain in the donor region and analgesic requirement of these patients were less compared to the patients with full-layer grafts. CONCLUSIONS The grafts taken from the center of the costa without breaking its integrity seem quite suitable for revision rhinoplasty surgeries. This technique prevents various morbidities and enables patients to have a more comfortable postoperative period. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Wang H, Wu L, Xu Y, Fan F, You J. Bilateral Fan-Shaped Septal Extension Struts in East Asian Augmentation Rhinoplasty. Aesthetic Plast Surg 2021; 45:652-660. [PMID: 32322931 DOI: 10.1007/s00266-020-01703-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For costal cartilage-based rhinoplasty, a method that could properly manage warping of the columellar strut graft and facilitate establishing a stable cartilaginous framework remains desirable. In this study, the authors present a new graft design named bilateral septal extension strut. It utilizes a pair of cartilage grafts with the shape of a fan, which are bilaterally fixated to the septum. Such "sandwiched" structure undertakes the combined functional roles of a columellar strut and a septal extension graft. METHODS Fifty-two female patients, ranging in age from 18 to 37 years, received augmentation rhinoplasty surgery based on the bilateral septal extension strut. Among these patients, 20 of them were primary cases, 26 secondary, and other six cases were tertiary. RESULTS Patients' own evaluations on the overall improvements in the nose rendered high satisfaction rate. There was no case of graft extrusion or infections. During the long-term follow-up, one case presented dorsal onlay graft warping and two cases presented in significant asymmetrical nostrils due to the deviation of the columellar at 12 months postoperatively and were corrected in the revision surgery. CONCLUSIONS The application of the bilateral septal extension struts can help mitigate the negative impact of strut graft warping, making it more manageable. As a result, reliable as well as sustainable support for both tip and lower lateral cartilages can be achieved in the long term. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Huan Wang
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, No. 33 Badachu Rd., Shijingshan District, Beijing, 100144, People's Republic of China
| | - Lehao Wu
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, No. 33 Badachu Rd., Shijingshan District, Beijing, 100144, People's Republic of China
| | - Yihao Xu
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, No. 33 Badachu Rd., Shijingshan District, Beijing, 100144, People's Republic of China
| | - Fei Fan
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, No. 33 Badachu Rd., Shijingshan District, Beijing, 100144, People's Republic of China
| | - Jianjun You
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute, No. 33 Badachu Rd., Shijingshan District, Beijing, 100144, People's Republic of China.
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Abstract
BACKGROUND Augmentation rhinoplasty in Asians may be effectively accomplished with alloplastic materials. However, certain circumstances such as nasal bone fractures mandate the use of autologous grafts. The purpose of this study was to describe and evaluate the results of modified osseocartilaginous rib cantilever grafting for aesthetic and reconstructive rhinoplasty in patients with acute nasal bone fractures. METHODS Forty-three patients with nasal bone fracture underwent surgical reconstruction with an autogenous rib graft. Anatomic reconstruction and dorsal augmentation were performed using 1 piece of a carved osseocartilaginous rib graft each for the bony and cartilaginous parts of the nose. The average time to surgery was 6.5 days, and patient's subjective satisfaction was scored. RESULTS "Excellent" or "good" cosmetic outcomes were reported by 37 patients (86%). There were 3 cases of secondary revision. Donor-site morbidity was not an issue in any patient. CONCLUSIONS Anatomic reconstruction of the nasal dorsum and refining the nasal tip using an osseocartilaginous rib graft with the cantilever technique are effective in acute nasal trauma patients who wish to enhance their nasal profile in the primary treatment setting.
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A Special Instrument for Harvesting the Split Rib Graft for Revision Rhinoplasty: Ors Retractor. Aesthetic Plast Surg 2020; 44:2340-2341. [PMID: 32936331 DOI: 10.1007/s00266-020-01954-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Abstract
Achieving a natural appearing dorsum in secondary rhinoplasty remains an elusive goal. An inherent contradiction exists between the two most usually used techniques: solid rib segment and diced cartilage fascia constructs. The former will often cause edge visibility, in addition to potential warping and distortion; the latter prevents from both but may generate obtuse, ill-defined borders with poor shape control, possible contour asymmetries, and often a tubular appearance. A solution to the equation can be found in an innovative technique that combines three elements: perichondrium, rectus fascia, and a rib lamination. The combination is called the sandwich of perichondrium and fascia (SPF) or the sandwich of perichondrium, rib lamination, and fascia (SPLF). As a single unit over the entire dorsum, the issues of junction irregularity inherent in the use of separate graft segments, and of asymmetries in the dorsal contour because of inadequate distribution of diced cartilage, are avoided. In a greater than 18-month experience on 23 cases at the time of writing, the SPF-SPLF graft has proved to be an ideal solution. Adequate edge definition and elegant related shadowing are provided, precise tailoring is attained, and proper height of the dorsum contour is reestablished, following adequate reconstruction of the underlying dorsal plateau. The gradual flow from SPF to SPLF is logical and progressive according to need, and proper fixation ensures long-term stability of the hybrid construct. All three elements required are harvested from the same donor site with a resulting minimal scar.
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Hakimi AA, Foulad A, Ganesh K, Wong BJF. Association Between the Thickness, Width, Initial Curvature, and Graft Origin of Costal Cartilage and Its Warping Characteristics. JAMA FACIAL PLAST SU 2020; 21:262-263. [PMID: 30816909 DOI: 10.1001/jamafacial.2018.2093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amir A Hakimi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Allen Foulad
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Kevin Ganesh
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange.,Department of Biomedical Engineering, Samueli School of Engineering, University of California, Irvine
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Reply: Measurement of Warping Angle in Human Rib Graft: An Experimental Study. Plast Reconstr Surg 2018; 142:799e-800e. [PMID: 30256282 DOI: 10.1097/prs.0000000000005178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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