No abstract

he 3 primary donor sites for autologous cartilage graft material in rhinoplasty and nasal reconstruction are the nasal septum, ear, and rib. Nasal septal cartilage is most commonly used owing to its ease of harvest within the surgical field without significant additional donor site morbidity. The thickness, flat contour, and durability of nasal septal cartilage are favorable qualities for long-term strength and support. Although septal cartilage is often the preferred choice in grafting material, its use may be limited by availability, particularly in noses that were previously operated on or traumatized. To overcome this problem, more recent efforts in tissue engineering have been directed toward creating new cartilage in vitro and in vivo using mesenchymal stem cells and progenitor cells seeded onto scaffolds. 1 Age-related changes in the chemical composition of human cartilage are well documented. Much of the information on this subject has been derived from studies on articular cartilage. Aging has been studied extensively in normal and osteoarthritic joint cartilage, where significant decreases in proteoglycan content are accompanied by mechanical weakening of the cartilage. 2 Although they are associated with aging, it remains unclear whether these findings are specific for degenerative and osteoarthritic cartilage rather than the normal aging process. As a result, it remains difficult to extrapolate this data to nasal cartilage, which does not undergo the same degree of mechanical stress in the nose. The notion that the quality and strength of nasal cartilage declines with advancing age is a commonly accepted be-IMPORTANCE Understanding age-related changes is important when considering cartilage-based implants or grafts during rhinoplasty and nasal reconstructive surgery. OBJECTIVE To characterize the cellular and architectural changes in human nasal cartilage with aging. DESIGN Laboratory study. PARTICIPANTS Nasal septal cartilage was harvested from 50 consecutive patients undergoing septoplasty, rhinoplasty, or septorhinoplasty. INTERVENTION Cartilage specimens were stained with hematoxylin-eosin (H&E) and safranin O for cartilage. MAIN OUTCOME MEASURES A modified Mankin histologic grading scale was used to analyze each cartilage sample for H&E findings and safranin O staining. Higher H&E scores indicated more degenerative changes, while higher safranin O scores indicated reductions in proteoglycan content within the cartilage matrix, representing decreased active chondrocyte activity. Correlation between H&E and safranin O scores and patient age was determined. RESULTS There was positive correlation between safranin O staining scores and age, with higher scores seen with advancing age (P = .01). A linear regression best-fit equation was determined to calculate a potential safranin O staining score for a given age. CONCLUSIONS AND RELEVANCE We have quantitatively determined that advancing age is positively correlated with reductions in cartilage proteoglycan content and active cartilage growth. This find...

IMPORTANCE The decision whether to discontinue antiplatelet and/or anticoagulant medications before a facial plastic surgical procedure is a complicated and multifactorial process that involves weighing the risk of perioperative thromboembolic complications with bleeding-related complications. OBJECTIVE To determine the complication rates in patients who undergo a range of facial plastic surgical procedures while receiving antiplatelet and/or anticoagulation therapy. DESIGN, SETTING, AND PARTICIPANTS A total of 9204 surgical procedures from January 1, 2007, through December 31, 2012, at an academic medical center and its affiliated surgical sites were analyzed, with patients who continued receiving antiplatelet and/or anticoagulation (aspirin, clopidogrel bisulphate, and warfarin sodium) therapy during the perioperative period identified and compared with a matched case-control group of patients who did not receive antiplatelet and/or anticoagulation therapy during this period. INTERVENTIONS Facial plastic surgery procedures and perioperative management. MAIN OUTCOME AND MEASURES Complication rates of wound healing (dehiscence or necrosis), infection, bleeding (hematoma or ecchymosis), and return to the operating room. RESULTS Patients who received aspirin therapy at the time of surgery were not more likely to have a complication compared with control patients (odds ratio [95% CI], 0.73 [0.45-1.17]). Patients who received warfarin had increased perioperative bleeding (odds ratio [95% CI], 3.80 [1.15-12.60]) and postoperative infections (odds ratio [95% CI], 7.29 [1.17-45.40]) compared with control patients. Serious complications (flap necrosis, dehiscence, or return to the operating room) were not increased with warfarin use. CONCLUSIONS AND RELEVANCE This study demonstrates that patients who undergo facial plastic surgery may continue taking antiplatelet and/or anticoagulation therapy during the perioperative period safely with minimal serious complications. LEVEL OF EVIDENCE 3.