The Rate of Warping in Irradiated and Nonirradiated Homograft Rib Cartilage: A Controlled Comparison and Clinical Implications

Abstract

Irradiated homograft costal cartilage reportedly warps less than autologous cartilage based on clinical observation; however, no controlled, experimental studies on the warping characteristics of irradiated homograft costal cartilage have been done. Fresh cadaver costal cartilage (ribs 5 through 8) was prepared and irradiated using a standardized technique. A specially designed cartilage-cutting device was used to cut the cartilage into a reproducible size. The irradiated (n = 23) and nonirradiated (n = 20) groups were incubated in vitro and assessed over a 4-week period. There was no significant difference in warping between the irradiated and nonirradiated groups (p = 0.1). The centrally cut pieces of cartilage in each group warped less than peripherally cut blocks in each group. Peripherally cut pieces of both the irradiated and nonirradiated groups warped at a faster rate compared with the nonirradiated groups. All cartilage exhibited continued warping over the 4-week study period. We concluded that there was no difference in warping characteristics between irradiated and nonirradiated homograft rib cartilage. Furthermore, unlike previous studies, cartilage grafts continued warping over time for at least 4 weeks, and this phenomenon may be extrapolated as a causative factor in delayed postoperative nasal deviation after rhinoplasty and nasal reconstruction where rib grafts are used.

Use of Autologous Costal Cartilage in Asian Rhinoplasty

“…Two extreme opinions coexist: one insists that irradiated homologous costal cartilage is well tolerated as a grafting material in rhinoplasty and yields superb functional, structural, and cosmetic results, 11,12 and the other insists that irradiated homologous costal cartilage absorption is unpredictable with lack of long-term study. [13][14][15] The authors used irradiated homologous costal cartilage in 40 cases of rhinoplasty during the same study period. From the author's (H.R.J.)…”

Effects of Carving Plane, Level of Harvest, and Oppositional Suturing Techniques on Costal Cartilage Warping

“…2,26 The novel concept of balanced cross-sectional carving and central harvest introduced by Gibson and Davis was further supported and reproduced by work from others, including Harris et al and Adams et al, and had significantly decreased the high incidence of warping originally commonly seen with costal cartilage grafts for nasal reconstruction and rhinoplasty. 32,33 Central and balanced cross-sectional carving assisted in decreasing the degree of warping observed with costal cartilage but, unfortunately, does not eliminate it. Techniques such as variation in level of harvest, cartilage irradiation, inclusion of an osseous component, and internal Kirschner wire placement have all been introduced in attempts to prevent intrinsic warping of costal cartilage.…”

Reconstructing the Extended Nasal Tip Defect

“…It is optimal to harvest the rib early and allow it to sit submerged in NS for 30 to 60 minutes to allow initial warping to occur. 7 The central "core" of rib is then carved to remove approximately equal amounts of excess cartilage from each side of the core. By evenly carving away the lateral/external portions of the rib, chances of further warping and distortion are reduced significantly.…”