Donor-Site Morbidity Following Harvest of Autologous Costal Cartilage in Microtia Reconstruction

Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are equally important factors which influence donor-site deformity in microtia reconstruction.

Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene(ePTFE)in Asian rhinoplasty were presented in this study.Objectives The purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.Methods Seventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed.Graft types,complications associated with the graft itself or graft harvesting,surgical outcomes,and patient satisfaction were assessed.Results The mean follow-up time post-operation was 13.5 months.A total of 42/75 patients underwent revision surgeries.Graft-related complications were found in 8%of cases,including two warped graft and four infection cases.Three individuals with infections had mild graft resorption.One patient with an infection removed the implant.Graft exposure,mobility,and substantial resorption were not recorded.A total of two cases underwent revision procedures for infection and perforation,respectively.Chest incision lengths for graft harvesting averaged 2.1 cm.No pneumothorax or significant donor-site pain was found.Donor-site scars were negligible,although two cases had hypertrophic chest scars.In general,functional and esthetic outcomes were mostly satisfactory among the assessed patients.Conclusions Rhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring.Meanwhile,ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes.Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent,long-lasting results with minimal risk;however,the potential for infection should be considered following revision surgery.

Application of Autologous Costal Cartilage Scaffold in Reconstruction of Microtia Ear

Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia reconstruction in our hospital were selected,all of whom were type II or type III pediatric deformities.All patients underwent auricle reconstruction and retroauricular skin expansion and autologous costal cartilage stent.The first stage of the operation is to insert a skin dilator behind the residual ear and inject water to expand.The second stage of the operation is to carve and repair the soft ribs(usually 6 or 7 ribs)from the body,make a three-dimensional auricle support for auricle reconstruction,place a negative pressure drainage tube,and follow up for 3 to 6 months to observe the three-dimensional shape of the reconstructed auricle and the formation of cranioauricular angle.Results 41 patients with microtia had good three-dimensional shape of auricle reconstruction,normal auricle position,moderate cranioauricular angle,good helix and triangular fossa structure,and good bilateral symmetry.Patients and their families were satisfied with the effect of auricle reconstruction.Conclusion Autologous costal cartilage is a good scaffold for auricle reconstruction.It is through efficient and elaborate carving and splicing that a good three-dimensional auricle structure can be formed.Combined with early flap expansion,a good postoperative appearance effect can be obtained,which is the appropriate method for auricle reconstruction at present.

The current trend of autologous costal cartilage harvest by facial plastic surgeons for rhinoplasty in the United States

Aim: To assess the safety profile and practice trend of autologous costal cartilage harvest by facial plastic surgeons in the United States (US).Methods: A 10-question online survey was distributed by the American Academy of Facial Plastic and Reconstructive Surgery to its members.Results: Of the 2,639 members, 2,379 received the survey with 137 (5.76%) members responded. The majority (33.6%)of the respondents were expert facial plastic surgeons. One hundred and nine (79.6%) of the respondents performed rib harvest with 49.6% of them performing the procedure at a hospital facility. Among them, 21.5% exclusively performed their surgery at an ambulatory surgical center not physically attached to a hospital while 6.67% of them at the in-office accredited operating room. When comparing techniques, 64.7% performed only full-thickness rib grafts vs. 12.0%harvesting partial-thickness rib grafts. Most used an incision length between 2.1 and 4 cm (64.4%) while 2 surgeons used < 1 cm incision. The occurrence of pneumothorax after autologous rib harvest remained low (< 1%) in most (73.1%).Regarding safety practices of the surgeons, only 24.6% would order a chest X-ray post-operatively while 54.5% would not. In addition, 58.7% of respondents never kept their patients overnight for observation after autologous rib grafting while 15.0% always would. For pain management, most respondents (50.4%) did not utilize any additional analgesia protocol besides oral pain medications.Conclusion: Two thirds of the US facial plastic surgeons performed autologous costal cartilage harvest in a hospital setting. Routine chest imaging or overnight observation post-operatively was not warranted as the percentage of pneumothorax remained low and pain control was adequate.