Abstract
Background
Diced cartilage grafts have long been used in rhinoplasty. Along with their various reported advantages, they also have some disadvantages. The irregular resorption rate of the engrafted mass is one of the major issues noted with diced cartilage grafts. An explanation for the unpredictable resorption rate has not yet been elucidated. This study aimed to determine the role of traumatized versus nontraumatized cartilage as the source of diced cartilage grafts.
Methods
This study included the noses of 32 patients (19 traumatized noses and 13 nontraumatized noses) who underwent surgery using Surgicel-wrapped diced cartilage grafts.
Results
The most remarkable result noted in this study was that a Surgicel-wrapped diced cartilage graft, if prepared from traumatized cartilage (in 19 patients), failed to maintain a stable long-term volume. Partial volume loss was noted in 100% of these patients. However, the rate of this partial resorption was different for every individual and could not be predicted. The highest retention of cartilage graft volume was seen primarily over the nasal osseocartilaginous junction. In nontraumatized patients, however, the engrafted mass maintained long-term volume stability. These patients evidenced no visible external irregularities, and only a few very slight imperfections were noted with finger palpation.
Conclusion
Diced cartilage of traumatic origin is not recommended for any purpose. In such cases, the authors’ engrafting algorithm consists of autobone or ear conchal cartilage grafts for dorsal augmentation, columellar struts from the nontraumatized part of the septum, and spreader grafts from the nontraumatized part of the septum or ear concha.
Similar content being viewed by others
References
Acarturk S, Arslan E, Demirkan F, Unal S: An algorithm for deciding alternative grafting materials used in secondary rhinoplasty. J Plast Reconstr Aesthet Surg 59:409, 2006
Arslan E, Unal S, Demirkan F, Gurbuz O, Beden V: Augmentation rhinoplasty with a combination of triple cartilage grafts for secondary rhinoplasty in a middle-aged population. Aesth Plast Surg 29:240, 2005
Aston JE, Bentley G: Repair of articular surfaces by allografts of articular and growth-plate cartilage. J Bone Joint Surg 68:29, 1986
Chen CT, Burton-Wurster N, Borden C, Hueffer K, Bloom SE, Lust G: Chondrocyte necrosis and apoptosis in impact damaged articular cartilage. J Orthop Res 19:703, 2001
Daniel RK, Calvert JW: Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113:2156, 2004
D’Lima DD, Hashimoto S, Chen PC, Colwell CW, Lotz MK: Human chondrocyte apoptosis in response to mechanical injury. Osteoarthritis Cartilage 9:712, 2001
Erol OO: The Turkish delight: A pliable graft for rhinoplasty. Plast Reconstr Surg 105:2229, 2000
Ertas NM, Hucumenoglu S, Besalti O, Ozak A, Celebioglu S: The effect of oxidized regenerated cellulose on diced cartilage xenograft: An experimental study. Ann Plast Surg 45:224, 2000
Gu Z, Shibata T, Cao Z, Feng J, Hu J: Chondrocyte apoptosis in temporomandibular joints with disc displacement. J Oral Maxillofac Surg 60:1026, 2002
Guerrerosantos J: Temporoparietal free fascia grafts in rhinoplasty. Plast Reconstr Surg 74:465, 1984
Guerrerosantos J, Trabanino C, Guerrerosantos F: Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty. Plast Reconstr Surg 117:804, 2006
Loening AM, James IE, Levenston ME, Badger AM, Frank EH, Kurz B, Nuttall ME,Hung HH, Blake SM, Grodzinsky AJ, Lark MW: Injurious mechanical compression of bovine articular cartilage induces chondrocyte apoptosis. Arch Biochem Biophys 381:205, 2000
Lucchinetti E, Adams CS, Horton WE Jr, Torzilli PA: Cartilage viability after repetitive loading: A preliminary report. Osteoarthritis Cartilage 10:71, 2002
Mostafapour SP, Hockenbery DM, Rubel EW: Life and death in otolaryngology: Mechanisms of apoptosis and its role in the pathology and treatment of disease. Arch Otolaryngol Head Neck Surg 125:729, 1999
Patwari P, Gaschen V, James IE, Berger E, Blake SM, Lark MW, Grodzinsky AJ, Hunziker EB: Ultrastructural quantification of cell death after injurious compression of bovine calf articular cartilage. Osteoarthritis Cartilage 12:245, 2004
Redman SN, Dowthwaite GP, Thomson BM, Archer CW: The cellular responses of articular cartilage to sharp and blunt trauma. Osteoarthritis Cartilage 12:106, 2004
Tew SR, Kwan AP, Hann A, Thomson BM, Archer CW: The reactions of articular cartilage to experimental wounding: Role of apoptosis. Arthritis Rheum 43:215, 2000
Tung Chen C, Wurster NB, Borden C, Hueffer K, Bloom SE, Lust G: Chondrocyte necrosis and apoptosis in impact damaged articular cartilage. J Orthop Res 19:703,2001
Yilmaz S, Erocen AR, Can Z, Yenidunya S, Edali N, Yormuk E: Viability of diced crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 109:1054, 2001
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arslan, E., Majka, C. & Polat, A. The Fate of Diced Cartilage Grafts of Traumatized Versus Nontraumatized Origin. Aesth Plast Surg 31, 365–371 (2007). https://doi.org/10.1007/s00266-006-0113-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-006-0113-9