Grafts

Abstract

After inserting several thousand grafts during rhinoplasty operations, 1 have come to 10 conclusions. 1. Grafts must be an integral part of analysis and operative planning for a rhinoplasty and not an obligate intraoperative necessity. The decision to do a tip graft or a radix graft will dictate the amount of dorsal reduction and often the operative approach. 2. One must be adept at using all of the donor materials and not be dependent on only one. Although septum is usually sufficient in primary cases, it is often insufficient in secondary cases and one must be able to make a dorsal or columellar strut from concha. 3. One should be able to harvest a graft quickly. If it is difficult to take grafts, then one will often rationalize why they are not needed. 4. Graft shaping and recipient bed preparation are of equal importance. Often, one will spend considerable time fashioning a perfect dorsal graft only to leave a small prominence in the keystone area which will act as a fulcrum and distort the dorsum. 5. The least done to a graft the better. I am dubious of the long-term survival of crushed and even bruised cartilage grafts; use solid-shaped grafts. 6. Fixation of the graft most often requires sutures with the open approach as one does not have the tight pockets of the closed approach. 7. Antibiotic coverage is important including intravenous dosage during the operation and five days postoperatively. The majority of reported infections do not include antibiotic coverage. 8. Alloplasts may be a short cut for the surgeon, but it increases the risk of failure for the patient. 9. Autogenous grafts rarely extrude, can withstand infection and have definitely stood the test of time. 10. Grafts have dramatically improved the quality of our rhinoplasty result, allowing for a more natural functional primary result, and a heretofore unobtainable nonoperative look in secondary cases.