Grafts

Abstract

After inserting several thousand grafts during rhinoplasty surgery, I have come to ten conclusions. First, grafts must be an integral part of analysis and operative planning, not an intraoperative necessity. For example, the decision to do a radix graft will influence the amount of dorsal reduction. Second, one must be adept at using all types of donor materials and not be dependent on just one. Although septum is usually sufficient in primary cases, it is often insufficient in complex secondaries thereby making rib grafts essential. Third, one should be able to harvest a graft quickly. If it is difficult to take a graft, then one will often rationalize why it is not needed. Four, graft shaping and recipient bed preparation are of equal importance. Five, the less done to a graft the better it is. I am dubious of the long-term survival of crushed and even bruised cartilage grafts. Six, fixation of the graft most often requires sutures during an open approach, as one does not have the tight pockets of the closed approach. Seven, antibiotic coverage is important including an intravenous dose during the operation and 5 days postoperatively. Eight, alloplasts may be a shortcut for the surgeon, but it increases the risk of failure for the patient. Nine, autogenous grafts rarely extrude, can withstand infection, and have definitely stood the test of time. One only needs to contrast the efficacy of autogenous cartilage versus the inevitable absorption of cadaver cartilage. Ten, grafts have dramatically improved the quality of our rhinoplasty results, allowing for a more natural functional primary result, and a heretofore unobtainable nonoperative look in secondary cases.