The Turkish Delight: A Pliable Graft for Rhinoplasty

Abstract

In nose surgery, carved or crushed cartilage used as a graft has some disadvantages, chiefly that it may be perceptible through the nasal skin after tissue resolution is complete. To overcome these problems and to obtain a smoother surface, the authors initiated the use of Surgicel-wrapped diced cartilage. This innovative technique has been used by the authors on 2365 patients over the past 10 years: in 165 patients with traumatic nasal deformity, in 350 patients with postrhinoplasty deformity, and in 1850 patients during primary rhinoplasty. The highlights of the surgical procedure include harvested cartilage (septal, alar, conchal, and sometimes costal) cut in pieces of 0.5 to 1 mm using a no. 11 blade. The fine-textured cartilage mass is then wrapped in one layer of Surgicel and moistened with an antibiotic (rifamycin). The graft is then molded into a cylindrical form and inserted under the dorsal nasal skin. In the lateral wall and tip of the nose, some overcorrection is performed depending on the type of deformity. When the mucosal stitching is complete, this graft can be externally molded, like plasticine, under the dorsal skin. In cases of mild-to-moderate nasal depression, septal and conchal cartilages are used in the same manner to augment the nasal dorsum with consistently effective and durable results. In cases with more severe defects of the nose, costal cartilage is necessary to correct both the length of the nose and the projection of the columella. In patients with recurrent deviation of the nasal bridge, this technique provided a simple solution to the problem. After overexcision of the dorsal part of deviated septal cartilage and insertion of Surgicel-wrapped diced cartilage, a straight nose was obtained in all patients with no recurrence (follow-up of 1 to 10 years). The technique also proved to be highly effective in primary rhinoplasties to camouflage bone irregularities after hump removal in patients with thin nasal skin and/or in cases when excessive hump removal was performed. As a complication, in six patients early postoperative swelling was more than usual. In 16 patients, overcorrection was persistent owing to fibrosis, and in 11 patients resorption was excessive beyond the expected amount. A histologic evaluation was possible in 16 patients, 3, 6, and 12 months postoperatively, by removing thin slices of excess cartilage from the dorsum of the nose during touch-up surgery. This graft showed a mosaic-type alignment of graft cartilage with fibrous tissue connection among the fragments. In conclusion, this type of graft is very easy to apply, because a plasticine-like material is obtained that can be molded with the fingers, giving a smooth surface with desirable form and long-lasting results in all cases. The favorable results obtained by this technique have led the authors to use Surgicel-wrapped diced cartilage routinely in all types of rhinoplasty.

Efficacy of diced cartilage graft in dorsal augmentation rhinoplasty and comparison with solid block cartilage

“…Surgicel wrapped diced cartilage, also termed as "Turkish delight" has been used by Erol in a series of 2000 patients and by Daniel and Calvert in their series of 22 patients. 4,5 The later reported their experience with surgicel wrapped diced cartilage as unsuccessful as in almost all the cases there was graft resorption and failure. Later Daniel had a successful series of 79 patients with diced cartilage wrapped in fascia graft.…”

Effect of scopoletin on fascia-wrapped diced cartilage grafts

“…However, the resorption rate may be unpredictable even if the cartilage graft is placed under optimal conditions [16]. There are several techniques that can increase the survival of diced cartilage grafts, including the Turkish delight method described by Erol, which has proven effective and popular around the world [3]. Surgically wrapped diced cartilages exhibit various degrees of resorption; thus, it has been recommended that fascia be used to wrap diced cartilages.…”

“…Subsequently, various types of cartilage graft have been used by surgeons to maintain the structural integrity of a patient's body [2]. The graft resorption rate is affected by a variety of parameters, including surgical trauma, graft preparation, and shape; anaesthetic deformities and defective contours can result from excessive resorption rates [3,4].…”

Diced Cartilage: An Effective Graft for Post-Traumatic and Revision Rhinoplasty

“…Their utility in rhinoplasty has been studied and highlighted by various authors [2][3][4]. The use of diced cartilage chopped into 0.5-1 mm pieces was first introduced by Peer [5] and then popularised by Erol [6]. It is probably the best of fillers available to camouflage various forms of nasal defects like that at radix, half length, full length, peri-pyriform, infra-lobule or lateral nasal wall.…”