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Mechanical properties of extensive calcified costal cartilage: An experimental study. Heliyon 2023; 9:e13656. [PMID: 36865463 PMCID: PMC9970894 DOI: 10.1016/j.heliyon.2023.e13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Background Autologous costal cartilage is widely used as nasal augmentation or nasal reconstruction material. However, no study has focused on the mechanical difference between no calcified costal cartilage and extensive calcified costal cartilage at present. Our study aims to study the loading behavior of calcified costal cartilage under tensile and compressive stress. Method Human costal cartilage specimen was obtained from five extensive calcified costal cartilage patients and classified into four groups (group A: no calcified costal cartilage; group B: calcified costal cartilage; group C: no calcified costal cartilage after transplantation in BALB/c nude mice for half a year; group D: calcified costal cartilage after transplantation in BALB/c nude mice for half a year). Young's modulus, stress relaxation slope, and relaxation amount were analyzed through tensile and compressive tests using a material testing machine. Results We included five female patients with extensive calcified costal cartilage. Group B exhibited significantly higher Young's modulus in both the tensile and compressive tests (p < 0.05 in tensile test, p < 0.01 in compressive test), higher relaxation slope (P < 0.01) and higher relaxation amount (p < 0.05 in compression test). After transplantation, the Young's modulus of calcified and non-calcified costal cartilage decreased, except that the calcified costal cartilage increased slightly in the tensile test. The final relaxation slope and relaxation amount had increased at different degrees, but the changes did not change significantly before and after transplantation (P > 0.05). Conclusion Our results showed that the stiffness of calcified cartilage would increase 30.06% under tension and 126.31% under compression. This study may provide new insights to researchers focusing on extensive calcified costal cartilage can be used for autologous graft material.
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Effect of Stromal Vascular Fractions on Angiogenesis of Injected Diced Cartilage. J Craniofac Surg 2022; 33:713-718. [PMID: 35013075 PMCID: PMC8865209 DOI: 10.1097/scs.0000000000007996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: This study explored the effect of adipose-derived stromal vascular fractions (SVFs) on angiogenesis in injected autologous diced cartilage. Methods: Stromal vascular fractions were extracted by enzymatic digestion. Cartilage grafts were harvested from 1 side of the auricular cartilage of New Zealand rabbit and then diced to a size of 1.0 mm3. The grafts were divided into 2 groups. The control group was diced cartilage mixed with culture medium, and the experimental group was diced cartilage mixed with SVFs. The 2 groups of composite grafts were subcutaneously implanted on both sides of the back of each rabbit. After 4, 12 and 24 weeks, the tissue structure, number of blood vessels, and angiogenic factors in the grafts were observed. Results: The SVFs conformed to the current standard of the biological evaluation. Under an inverted microscope, the number of layers of chondrocytes in the experimental group was higher than that in the control group at 4 weeks. A small number of inflammatory cells and blood vessels were observed around the cartilage grafts. At 12 and 24 weeks, the volume of tissue was increased gradually by general observation. And a large number of chondrocytes were observed microscopically, whereas the number of inflammatory cells decreased. And meanwhile additional new blood vessels were observed. Immunohistochemical analysis of CD31 showed that the number of capillaries in the control group was significantly lower than that in the experimental group at 4, 12 and 24 weeks. Further, the expression of Hypoxia inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF) mRNA and protein were measured by RT-PCR and Western bloting, respectively. The results showed that the mRNA expression of VEGF and HIF-1α in the experimental group was increased. The mRNA level remained higher than that of the control group at 24 weeks (P < 0.05). And the relative expression levels of VEGF and HIF-1α protein in the experimental group were higher than those in the control group at 4, 12 and 24 weeks (P < 0.05). Conclusion: Autologous diced cartilage mixed with adipose-derived SVFs can promote angiogenesis when transplanted by injection. Further research showed that SVFs could increase the expression levels of VEGF and HIF-1α in the grafts, which may be part of the mechanism that SVFs promoted the angiogenesis of diced cartilage.
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Effects of Esterified Hyaluronic Acid, Adipose Tissue, and Blood Glue on Survival of Diced Cartilage Grafts. J Craniofac Surg 2021; 33:1614-1618. [PMID: 34690319 DOI: 10.1097/scs.0000000000008304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Diced cartilage grafts are used for correcting nasal dorsal deformities and irregularities. However, cartilage resorption is among most common problems after rhinoplasty. The purpose of this experimental study was to investigate the effects of esterified hyaluronic acid, adipose tissue, and blood glue on the viability of diced cartilage grafts. METHODS A total of 24 Wistar albino rats were used for the study. Cartilage grafts were obtained from 1 side ear and diced. The rats were divided into 4 groups (6 in each group): bare diced cartilage (group 1), diced cartilage wrapped with adipose tissue (group 2), diced cartilage blended with blood glue (group 3), and diced cartilage wrapped with esterified hyaluronic acid (group 4). The grafts were inserted into the subcutaneous pockets of the back of same rat. After 2 months follow-up specimens were harvested for histopathological and dimensional examination. The sections were stained with Hematoxylin and Eosin, Masson-Trichrome, and Elastic Van-Gieson. Chronic inflammation, loss of chondrocyte nucleus, vascularization, foreign body reaction, collagen content of matrix, and extent of elastic fiber were assessed under light microscopy. RESULTS Foreign body reaction in adipose tissue and blood group was significantly higher than bare cartilage and esterified hyaluronic acid group (P = 0.001). With respect to loss of chondrocyte nucleus esterified hyaluronic acid group had significant higher rate of nucleus loss than other groups (P = 0.002). CONCLUSIONS This study suggests that blood glue, esterified hyaluronic acid and autologous adipose tissue have not beneficial effects in improving viability of diced cartilage grafts.
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Li J, Sang C, Fu R, Liu C, Suo L, Yan Y, Liu K, Huang RL. Long-Term Complications from Diced Cartilage in Rhinoplasty: A Meta-analysis. Facial Plast Surg Aesthet Med 2021; 24:221-227. [PMID: 34357798 DOI: 10.1089/fpsam.2021.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To analyze the incidences of long-term complications and revision surgery associated with diced cartilage grafts in dorsal augmentation rhinoplasty. Methods: The PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for clinical studies on the use of diced cartilage for dorsal augmentation published. A meta-analysis was conducted to pool the estimated rates of infection, overcorrection, visible irregularity, absorption, and revision surgery. Result: A total of 14 studies involving 2380 patients were included in the systematic review. The combined rates were 11.5% for overall complications and 5.3% for revision surgery. The rates of the most frequently reported complications were 4.5% for infection, 5.3% for visible irregularity, 0.7% for overcorrection, and 0.5% for absorption. There was no significant difference in the rates of visible irregularity (p = 0.23) and revision surgery (p = 0.71) among the wrapped diced cartilage, glued diced cartilage, and free diced cartilage groups. Conclusion: This meta-analysis presents the first comprehensive and quantitative report of long-term complications associated with diced cartilage in dorsal augmentation rhinoplasty. Infection and visible irregularity were the most frequently reported complications. The rates of irregularity and revision surgery were not correlated with the diced cartilage packing methods.
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Affiliation(s)
- Jiaqi Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Sang
- Department of Plastic and Burn Surgery, Zhucheng People's Hospital, Shanghai, China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Linlang Suo
- Department of Surgery, Shanghai Eighth People's Hospital, Shanghai, China
| | - Yuxin Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shi Y, Guo R, Hou Q, Hu H, Wang H, Jiang H. The Effect of Perichondrium on Biological and Biomechanical Properties of Molded Diced Cartilage Grafts. Aesthetic Plast Surg 2020; 44:549-557. [PMID: 31932888 DOI: 10.1007/s00266-019-01581-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/07/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diced cartilage is a significant alternative approach to cartilage grafting. However, the viability and biomechanical properties of diced cartilage grafts remain to be improved, and the role of perichondrium is largely neglected. This study aimed to evaluate the histological and biomechanical effects of perichondrium on custom-shaped diced cartilage grafts constructed via a high-density porous polyethylene mold. METHODS Seven New Zealand rabbits were used. Unilateral auricular cartilage was harvested and divided into 2 parts, with or without perichondrium, diced into 1 × 1 × 0.5 mm cubical pieces, and filled into high-density porous polyethylene molds. Three grafts with the perichondrium removed and 3 with the perichondrium preserved were implanted subcutaneously at the dorsum. The grafts underwent biomechanical and histological tests 4, 8, and 12 weeks after the implantation. RESULTS The diced cartilage merged into integrated blocks without observable resorption in both groups at each time point. Additionally, the retention rate of weight was higher in the perichondrium-preserved group (P < 0.05). We observed regenerated cartilage that stained positively for type II collagen and glial fibrillary acidic protein (GFAP). A greater area of regenerated cartilage and higher scores of GFAP staining were observed in the perichondrium-preserved group (P < 0.05). The yield stress and modulus of elasticity were also higher in the perichondrium-preserved grafts from week 8 after implantation (P < 0.05). CONCLUSIONS Diced cartilage grafts with a custom shape can be constructed using a high-density porous polyethylene mold. The preservation of perichondrium can improve graft viability and biomechanical properties. LEVEL OF EVIDENCE This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Yingshen Shi
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China
- Department of Plastic Surgery, 260 Hospital, Sergeant School Affiliated to Army Medical University, Shijiazhuang, China
| | - Rong Guo
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China
| | - Qiang Hou
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China
| | - Hao Hu
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China
| | - Hui Wang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China.
| | - Hua Jiang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai, 200120, China.
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Liao J, Chen Y, Chen J, He B, Qian L, Xu J, Wang A, Li Q, Xie H, Zhou J. Auricle shaping using 3D printing and autologous diced cartilage. Laryngoscope 2019; 129:2467-2474. [PMID: 30843613 PMCID: PMC6850318 DOI: 10.1002/lary.27752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To reconstruct the auricle using a porous, hollow, three-dimensional (3D)-printed mold and autologous diced cartilage mixed with platelet-rich plasma (PRP). METHODS Materialise Magics v20.03 was used to design a 3D, porous, hollow auricle mold. Ten molds were printed by selective laser sintering with polyamide. Cartilage grafts were harvested from one ear of a New Zealand rabbit, and PRP was prepared using 10 mL of auricular blood from the same animal. Ear cartilage was diced into 0.5- to 2.0-mm pieces, weighed, mixed with PRP, and then placed inside the hollow mold. Composite grafts were then implanted into the backs of respective rabbits (n = 10) for 4 months. The shape and composition of the diced cartilage were assessed histologically, and biomechanical testing was used to determine stiffness. RESULTS The 3D-printed auricle molds were 0.6-mm thick and showed connectivity between the internal and external surfaces, with round pores of 0.1 to 0.3 cm. After 4 months, the diced cartilage pieces had fused into an auricular shape with high fidelity to the anthropotomy. The weight of the diced cartilage was 5.157 ± 0.230 g (P > 0.05, compared with preoperative). Histological staining showed high chondrocyte viability and the production of collagen II, glycosaminoglycans, and other cartilaginous matrix components. In unrestricted compression tests, auricle stiffness was 0.158 ± 0.187 N/mm, similar to that in humans. CONCLUSION Auricle grafts were constructed successfully through packing a 3D-printed, porous, hollow auricle mold with diced cartilage mixed with PRP. The auricle cartilage contained viable chondrocytes, appropriate extracellular matrix components, and good mechanical properties. LEVELS OF EVIDENCE NA. Laryngoscope, 129:2467-2474, 2019.
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Affiliation(s)
- Junlin Liao
- Departments of Medical Cosmetology, The First Affiliated Hospital, University of South China, Hengyang.,Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha
| | - Yong Chen
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha.,Emergency Department, The First Hospital of Changsha, Changsha
| | - Jia Chen
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha
| | - Bin He
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha.,Departments of Burn and Plastic Surgery, Ningxiang People's Hospital, Ningxiang, Hunan
| | - Li Qian
- Departments of Burn and Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha
| | - Jiaqin Xu
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha.,Departments of Burn and Plastic Surgery, Hainan People's Hospital, Haikou, Hainan
| | - Aijun Wang
- Department of Surgery, Davis Health System, University of California, Sacramento, California, U.S.A
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University Medical School, Ninth People's Hospital, Shanghai, People's Republic of China
| | - Hongju Xie
- Departments of Medical Cosmetology, The First Affiliated Hospital, University of South China, Hengyang
| | - Jianda Zhou
- Departments of Plastic and Reconstructive Surgery, The Third Xiangya Hospital, Central South University, Changsha
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