The distortion of autogenous cartilage grafts: Its cause and prevention

Gibson, Thomas; Davis, William B.

doi:10.1016/s0007-1226(57)80042-3

Cited by 412 publications

(166 citation statements)

References 7 publications

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“…7 The most important disadvantage of the balanced cross-sectional Oblique Split Technique in Septal Reconstruction Tastan, Sozen 489 carving method is the warping problem. 2,8 As the graft gets thinner the warping tendency increases. 9 However, the rhinoplasty surgeon needs straight grafts in varying thickness.…”

Section: Discussionmentioning

confidence: 99%

Oblique Split Technique in Septal Reconstruction

Taştan

Sözen

2013

Facial plast Surg

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The major obstacle for septal reconstruction surgery in the previously traumatized or operated septum is the availability of septal cartilage. A variety of materials, exogenous or autogenous, have been proposed for septal grafting. 1 Autogenous grafts, the more commonly used alternative, may be harvested from auricular conchal or rib cartilage. Often, extensive grafting is required necessitating a costal harvest. While costal grafts provide abundant cartilage they have a tendency to warp over time, which may translate into longterm failure for a septal reconstruction procedure. 2 A novel costal cartilage carving technique called "oblique split method (OSM)," introduced by the authors stands to eliminate warping by dividing the graft obliquely to provide equal circumferential forces of contracture. 3 In this article, this novel technique will be illustrated by the presentation of surgical technique and intra-and postoperative photographs of two patients (one open and one endonasal approach) operated for revision septorhinoplasty. MethodThe operation was performed in 69 patients. All had significant septal support problems due to previous surgery or nasal trauma. All of the septum reconstructions performed with the costal cartilage grafting. Seventh rib cartilage was used for grafting. An endonasal (n ¼ 21) or open (n ¼ 48) approach was used with the patient under general anesthesia. Appropriate informed consent was obtained. Surgical TechniqueMain purpose of our technique is to have straight, thin, adjustable, but durable costal grafts and reconstruct the nasal infrastructure suitably. 3 Superoinferior caliber of rib determines the length and anteroposterior caliber determines the width of the graft carved by OSM. Jung et al reported the seventh rib having the greatest anteroposterior caliber and length. 4 Therefore, a straight segment of the seventh rib is preferred; the right side is harvested for the surgeon's convenience. Around 3 to 4 cm of the rib segment is considered to be sufficient for any nasal deformity. A proximal and distal disc-shaped segment is excised from both ends of the rib segment according to the planned graft length. The over-and underlying perichondrium is elevated circumferentially and the costal cartilage is removed to be sculpted on the back table. A cross-sectional graft is obtained by splitting the rib AbstractThe septum is considered to be the most important anatomical structure in providing nasal support. Because of a variety of potential etiologies nasal septum could be severely deformed or even diminished. Autogenous cartilage has generally been considered the gold standard grafting material in reconstructive septal surgery for creating the infrastructure of the nose. In the restructuring of the nasal skeleton autogenous cartilage can be harvested from the auricle or the rib. For the major septal problems requiring a large volume of tissues with severe structural defects costal cartilage is considered the best graft material. Apart from its advantages, warping has been the main pr...

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Section: Discussionmentioning

confidence: 99%

Oblique Split Technique in Septal Reconstruction

Taştan

Sözen

2013

Facial plast Surg

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“…Rib also has a tendency to warp, 5,6 even with strict adherence to the methods outlined by Gibson and Davis. 7 The autogenous preserved cartilage has been well described for use in both aesthetic and reconstructive rhinoplasty surgery for well over 50 years (see reviews by Donald, 8 Sailer, 9 and Sarnat and Laskin 10 ). Many methods to preserve autogenous cartilage have been used, including refrigeration or freezing (typically at 0°-4°C) in saline 11,12 and plasma, 13 boiling, 14 preservation in merthiolate [15][16][17][18][19] or 2-ethylmercurithiobenzoxazole-5-carboxylic acid (Cialit), 20 immersion in ethanol or isopropyl alcohol, 21 storage in mecurochrome (L. Bernstein, DDS, MD, e-mail communication, February 2000), preservation in polyester resins, 22 and lyophilization.…”

Section: Commentmentioning

confidence: 99%

The Use of Preserved Autogenous Septal Cartilage in "Touch-up" Rhinoplasty

Wong

Giammanco²

2003

Archives of Facial Plastic Surgery

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“…We call it the "keystone" spot (Figs. 7,8). Very superficial scratching is made along the antihelical ridge and both its crura with the movements directed toward the keystone spot anteriorly using an otoabrader with very thin teeth (Fig.…”

Section: Operative Techniquementioning

confidence: 99%

“…Gibson and Davis [8] were the first to point out that the rib cartilage bends because "the matrix tends to expand while the outer stretched layer contracts." There is an elastic contraction of the superficial side when the cartilage is cut parallel to the surface.…”

Section: Scratching Of the Cartilagementioning

confidence: 99%

Aesthetic otoplasty: A new technique

Milojevic¹

1981

Aesth. Plast. Surg.

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Abstract.Our technique for the correction of the protruding ear deformity has been successfully used in 275 patients. It gives a natural look of the auricle, symmetrical results, and a decreased number of secondary surgical procedures. This technique is based on a careful planning of the operation and measurement of the auricle, a large posterior skin excision proportional to the protrusion, breaking of the keystone of the auricular cartilage (horizontal cut of the cartilage between the antitragus and antihelix for 10-12 mm), superficial scratching of the periochondrium of the antihelix, and deep scratching of the cartilage laterally and medially to the antihelix. The dressing remains on for only 24 hours. Key words: Protruding ear deformity --Aesthetic otoplastyThere are four basic types of ear protrusion in which aesthetic otoplasty is indicated: (1) poorly developed antihelix; (2) hypertrophy of the concha; (3) hypertrophy of the upper or lower pole of the auricle; and (4) normal shape of the external ear but the angle between the auricle and mastoid is considerably larger than normal.There is no other operation in aesthetic plastic surgery that has so many operative methods as aesthetic otoplasty. This may indicate that none of the operations in use at the moment is completely satisfactory. Surgeons are always trying to achieve better results using new methods. The most commonly used techniques for the correction of the protruding ear deformity are: 1. Complete exposure of the posterior perichondrium and full-thickness inci-9 sions of the cartilage on the posterior surface along the helix, antihelix, and conchal rim. The cartilage is thinned and tubed (Converse) [1].

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The distortion of autogenous cartilage grafts: Its cause and prevention

Cited by 412 publications

References 7 publications

Oblique Split Technique in Septal Reconstruction

Oblique Split Technique in Septal Reconstruction

The Use of Preserved Autogenous Septal Cartilage in "Touch-up" Rhinoplasty

Aesthetic otoplasty: A new technique

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