Reconstruction with Irradiated Homograft Costal Cartilage

Abstract

The authors present their experience with 51 patients who underwent 55 reconstructive and cosmetic operative procedures with irradiated homograft costal cartilage, who were studied between August of 1988 and June of 2001. The procedures included 52 rhinoplasties and three penile implantations among a total of 130 grafts. Follow-up ranged from 7 months to 12 years. There were two immediate graft exposure complications. Late complications included displacement of the graft in two patients, fracture of the graft in one patient, and partial resorption in one patient at 6 months postoperatively. The experience is described and the literature is reviewed.

Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose

“…They had no cases of warping or infection, and both clinical and histologic examination of the grafts in 2 patients after 7 months and 7 years did not show signs of resorption, which they believed indicated longevity of irradiated cartilage. Lefkovits,46 in his comment on the report by Strauch and Wallach, 45 emphasized that IHCC has the qualities of an ideal implant and suggested its usage be considered in augmentation rhinoplasty when septal cartilage is insufficient. In 2004, Burk et al 47 conducted a comparative study by reviewing 118 cases of nasal reconstruction using IHCC grafts with a mean follow-up period of 36 months vs 12 cases of auricular reconstruction using IHCC grafts.…”

“…Only 1 patient had a complication, warpage, which required removal of the IHCC graft. 44 In the following year, Strauch and Wallach 45 reported on 130 IHCC grafts in 52 cases of rhinoplasties and 3 penile reconstructions. They reported 1 case of partial resorption during a follow-up period of 7 months to 12 years.…”

Irradiated homograft cartilage in laryngotracheal reconstruction—A preliminary experience

“…A study of 122 patients who had rhinoplasties performed with irradiated costal cartilage showed that the most frequent early complications were due to infection. These were treated with antibiotics and did not affect the integrity of the graft [12]. Another animal model used tissue-engineered cartilage which showed good incorporation with the surrounding tissue and no evidence of necrosis [23].…”

“…The disadvantages of obtaining autograft rib cartilage include donor site pain and scar, risk of complications such as pneumothorax and wound breakdown, limited tissue availability, coordination between two busy surgical teams and increased operative time. Irradiated homograft costal cartilage has been successfully used in a wide variety of cosmetic and reconstructive procedures with good outcomes [12]. It is readily available, shortens surgical time and avoids donor site complications.…”

Surgical reconstruction in patients with cancer of the head and neck

“…If the patient's own resources are not available or suitable for cartilage graft harvesting, irradiated cadaveric cartilage from a tissue bank can be used without concerns about transmissible diseases [11]. Bone grafts obtained from the iliac crest, rib, or parietal bone (split calvarial graft) are more commonly used for support in nasal, orbital, or midface reconstruction when there is good vascular supply of the soft tissues needed to cover these grafts and if the graft size needed is relatively small.…”