Correction of Enophthalmos With Rib Bone Segment and Diced Cartilage Grafts:

Survey of In Situ Splitting Rib Harvesting Surgery for Orbital Deformity: Follow-Up

BACKGROUND

Our previous study indicated that in situ splitting rib harvesting surgery clinically reduced in related complications compared with the traditional surgical approach in the early stage, but there are few studies pay close attention to long-term recovery of donor area after rib harvesting. In this study, the authors conducted a follow-up study on recovery condition of donor and graft site of patients after in situ rib splitting grafting or simple whole rib grafting surgery.

METHODS

Between 2013 and 2016, 8 Chinese patients with orbital deformity were corrected using autogenous rib, of which 3 patients received conventional rib harvesting surgery, 3 patients received in situ splitting harvesting surgery, and 2 patients underwent both. In all patients, 3-dimensional computed tomography study of donor site and graft site were performed before and after operation. The ribs of donor site and graft site volume measurement were assessed using computed tomography 7 days and 12 months postoperation.

RESULTS

After 12 months operation, the integrity of rib arch recovered 94.1 ± 2.2% after in situ splitting rib harvesting, compared with 41.4 ± 5.0% after whole rib harvesting. The volume of grafted rib in situ splitting rib harvesting group reduced 69.8 ± 10.0% after 12 months operation compared with the volume after 1 week operation, and the reduced volume of ribs in whole rib harvesting group was 73.62 ± 9.5%.

CONCLUSION

Rib regeneration occurred more quickly by in situ rib splitting harvesting approach compared with the traditional surgical approach.

Technical note on the harvesting of rib osteochondral autografts for upper limb bone and joint repair surgery

Rib cartilage grafts are widely used in maxillofacial surgery, but not in orthopedic surgery. The aim of this technical note is to describe the technique used to harvest this graft and to report on donor site complications in the 136 cases we have published on up to now. Harvesting is carried out at the osteochondral junction of the eighth rib. The osteochondral junction is located under the external oblique muscle and a perichondrium layer, which is retracted to allow safe harvesting. The amount of cartilage harvested depends on the size of the area being grafted. Harvesting of a rib osteochondral graft is easy to carry out, provides a considerable amount of hyaline cartilage for the reconstruction of degenerative and traumatic lesions on a joint surface and results in few donor site complications.

Anatomical and computed tomography study of the eighth costochondral junction: topography for costochondral graft harvesting

INTRODUCTION

Costochondral grafts have long been used in maxillofacial reconstruction, but have been little used in trauma and orthopedic cases. This surgical technique requires that a graft be harvested from the thorax in the area of the eighth rib. Pleuropulmonary complications are very rare. Although the harvesting technique is simple, it needs to be demystified.

GOAL OF STUDY

This study was performed to define anatomical relationships in the eighth costochondral junction and identify topographical and anatomical landmarks that will make it easier to harvest this structure.

METHOD

This was a two-part study. First, an anatomical study was carried out on human cadaver thoraxes to define topographical landmarks and study the anatomical surroundings of the eighth costochondral junction. Second, an imaging study was performed using a database of existing patient computed tomography (CT) scans of the chest and abdomen to confirm the topographical landmarks defined in the first part of the study. The spine was used as a reference for both studies. The location of the eighth costochondral junction was defined relative to the spinal processes along with its location on the lower rib cage hemiperimeter in the transverse plane starting at the corresponding spinous process.

RESULTS

The eighth costochondral junction was in line with the spinal process of the twelfth thoracic vertebra in the vast majority of cases and located at two-thirds of the lower rib cage hemiperimeter from the posterior median sulcus, regardless of the patient's chest shape, age and gender. This junction was always located under a single muscle (external oblique) and protected by a thick perichondrium layer, which separates it from the intercostal pedicles, endothoracic fascia and parietal pleura.

DISCUSSION

This two-part study has identified reliable landmarks for harvesting of an osteochondral graft at the eighth costochondral junction and, by describing its anatomical surroundings, helps take the mystery out of its harvesting. These landmarks were identified in supine cadavers and in free-breathing patients lying in supine for the CT portion. This position must be used when identifying these landmarks in a patient undergoing costochondral autograft harvesting for cartilage reconstruction.