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
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References
Sheen JH (1984) Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73(2):230–239
Guyuron B, Michelow B, Englebardt C (1998) Upper lateral splay graft. Plast Reconstr Surg 102:2169–2177
Toriumi DM (2000) Autogenous grafts are worth the extra time. Arch Otolaryngol Head Neck Surg 126:562–564
Akcam T, Friedman O, Cook TA (2004) The effect on snoring of structural nasal valve dilatation with a butterfly graft. Arch Otolaryngol Head Neck Surg 130:1313–1318
Araco A, Gravante G, Araco F et al (2006) Autologous cartilage grafts rhinoplasties. Aesthetic Plast Surg 30:169–174
Gunter JP, Rohrich RJ (1990) Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 86:39–45
Porter JP (2000) Grafts in rhinoplasty, alloplastic vs autogenous. Arch Otolaryngol Head Neck Surg 126:558–561
Ansari K, Asaria J, Hilger P (2008). Grafts and implants in rhinoplasty techniques and long term results. Oper Tech Oto layngol and neck surg.19: 42–58
Yilmaz M, Vayvada H, Menderes A et al (2007) Dorsal nasal augmentation with rib cartilage graft: long-term results and patient satisfaction. J Craniofac Surg 18:1457–1462
Gibson T, Davis WB, Curran RC (1958) The long term survival of cartilage homografts in man. Br J Plast Surg 11:177–187
Ors S, Ozkose M, Ors S (2015) Comparison of various rhinoplasty techniques and long-term results. Aesthetic Plast Surg. 39(4):465–473
Davis PKB, Jones SM (1971) The complications of silastic implants: experience with 137 consecutive cases. Br J Plast Surg 24:405–411
Ors S (2017) Osseous-cartilaginous spreader graft and nasal framework reconstruction. Aesthetic Plast Surg. 41(5):1155–1163
Liang X, Wang K, Malay S, Chung KC, Ma J (2018) A systematic review and meta-analysis of comparison between autologous costal cartilage and alloplastic materials in rhinoplasty. J Plast Reconstr Aesthet Surg. 71(8):1164–1173
Ors S (2018) Measurement of warping angle in human rib graft: an experimental study. Plast Reconstr Surg. 141(5):1147–1157
Gibson T, Davis WB (1958) The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg 10:257–274
Fry HJ (1966) Interlocked stresses in human nasal septal carti-lage. Br J Plast Surg 19(3):276–278
Fry H (1967) Cartilage and cartilage grafts: the basic properties of the tissue and the components responsible for them. Plast Reconstr Surg 40(5):526–539
Kim DW, Shah AR, Toriumi DM (2006) Concentric and eccentric carved costal cartilage: a comparison of warping. Arch Facial Plast Surg. 8(1):42–46
Farkas JP, Lee MR, Lakianhi C, Rohrich RJ (2013) Effects of carving plane, level of harvest, and oppositional suturing techniques on costal cartilage warping. Plast Reconstr Surg. 132(2):319–325
Teshima TL, Cheng H, Pakdel A, Kiss A, Fialkov JA (2016) Transverse slicing of the sixth-seventh costal cartilaginous junction: a novel technique to prevent warping in nasal surgery. J Craniofac Surg. 27(1):e50–e55
ORS S (2020) A special instrument for harvesting the split rib graft for revision rhinoplasty: ORS retractor. Aesthet Plast Surg 44(6):2340–2341
Agaoglu G, Erol OO (2000) In situ split costal cartilage graft harvesting through a small incision using a gouge. Plast Recon-str Surg 106:932–935
Gaba S, Gupta R, Mishra B, Sahni D (2017) Harvesting split thickness costal cartilage graft. Indian J Plast Surg. 50(1):79–81
Nuara MJ, Loch RB, Saxon SA (2016) Reconstructive rhinoplasty using multiplanar carved costal cartilage. JAMA Facial Plast Surg. 18(3):207–211
Ors S (2020) Harvest of rib graft for rhinoplasty in breast implant patients. Plastic and Reconstr Surg-Global Open 8(5):e2809
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ORS, S. Harvesting Split Costal Cartilage Graft in Revision Rhinoplasty Without Disturbing the Costal Integrity. Aesth Plast Surg 45, 1191–1196 (2021). https://doi.org/10.1007/s00266-020-02108-z
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DOI: https://doi.org/10.1007/s00266-020-02108-z