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.

Fabrication and evaluation of an optimized xenogenic decellularized costal cartilage graft:preclinical studies of a novel biocompatible prosthesis for rhinoplasty

On account of the poor biocompatibility of synthetic prosthesis,millions of rhinoplasty recipients have been forced to choose autologous costal cartilage as grafts,which suffer from limited availability,morbidity at the donor site and prolonged operation time.Here,as a promising alternative to autologous costal cartilage,we developed a novel xenogeneic costal cartilage and explored its feasibility as a rhinoplasty graft for the first time.Adopting an improved decellularization protocol,in which the ionic detergent was substituted by trypsin,the resulting decellularized graft was confirmed to preserve more structural components and better mechanics,and eliminate cellular components effectively.The in vitro and in vivo compatibility experiments demonstrated that the decellularized graft showed excellent biocompatibility and biosecurity.Additionally,the functionality assessment of rhinoplasty was performed in a rabbit model,and the condition of grafts after implantation was comprehensively evaluated.The optimized graft exhibited better capacity to reduce the degradation rate and maintain the morphology,in comparison to the decellularized costal cartilage prepared by conventional protocol.These findings indicate that this optimized graft derived from decellularized xenogeneic costal cartilage provides a new prospective for future investigations of rhinoplasty prosthesis and has great potential for clinical application.

The key to costal cartilage in rhinoplasty

Autologous costal cartilage is an excellent source of graft in rhinoplasty due to its rich supply,durability,versatility,and functionality.For a long time,rhinoplasty surgeons have been critical of using autologous costal cartilage based on the potential for associated complications including donor site morbidities,postoperative pain,warping,and long operation time.Even with this criticism,costal cartilage is still a gra昀material of choice in cartilage depleting revision rhinoplasty.Recently,there has been a steady increase in costal cartilage use even in primary augmentation rhinoplasty,especially in Asian.

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.

Costal cartilage graft in Asian rhinoplasty: surgical techniques

Asian rhinoplasty is a very common cosmetic procedure.Many Asians desire a higher nasal bridge,for which they undergo several procedures,including filler injections,implantations and insertion of threads.Surgeons encounter many patients who have had several procedures done on them previously.In this paper,we introduce the use of autologous grafts for Asian rhinoplasty(primary and secondary),and discuss the rib carving techniques and difficulties encountered during harvesting,carving and placements of grafts and how to overcome these problems and prevent complications.

Total nasal septal reconstruction using costal cartilage in difficult cases of secondary septoplasty

Rhinoplasty and septal reconstruction often require the use of cartilage grafts.Complete nasal septal reconstruction may be required in very specific situations like difficult secondary septoplasty or severely deformed post traumatic noses.Usually in these cases the septal cartilage or bone is insufficient for septal reconstruction.The authors hereby describe a new technique of complete septal reconstruction by using the 7th rib(costal)cartilage combined with author’s ingenious technique to prevent warping.

Rhinoplasty in China: A review of the most important events in its history of development

A review of the literature in commonly used retrieval systems generally yields minimal or no pertinent information on the early works of Chinese doctors.Herein,the early works in rhinoplasty by pioneers Dr.Maolian Hu(胡懋廉)and Dr.PC Nyi(倪葆春)were retrieved from the database of Chinese Medical Journal published before1949 that overseas doctors could not gain access to online possibly due to the language barrier in collecting and processing those old professional data by main retrieval systyems.They published original articles on costal cartilage applications for correction of saddle noses in as early as 1939 and 1949,respectively,which represent the earliest attempts of treating nasal deformities with costal cartilages in China as well as in Asia.The private cosmetic surgical practices in rhinoplasty from the 1930s to the 1940s were recovered and briefly reviewed,and some of the most important clinical cases were presented.Other important events related to rhinoplasty,such as the establishment of the first national society of rhinoplasty in Chengdu,China in 2011 and the successful performance of the first national congress on rhinoplasty in Shanghai,China in 2012,were included.

Injectable cartilage matrix hydrogel loaded with cartilage endplate stem cells engineered to release exosomes for non-invasive treatment of intervertebral disc degeneration

Low back pain,mainly caused by intervertebral disc degeneration(IVDD),is a common health problem;however,current surgical treatments are less than satisfactory.Thus,it is essential to develop novel non-invasive surgical methods for IVDD treatment.Here,we describe a therapeutic strategy to inhibit IVDD by injecting hydrogels modified with the extracellular matrix of costal cartilage(ECM-Gels)that are loaded with cartilage endplate stem cells(CESCs).After loaded with CESCs overexpressing Sphk2(Lenti-Sphk2-CESCs)and injected near the cartilage endplate(CEP)of rats in vivo,ECM-Gels produced Sphk2-engineered exosomes(Lenti-Sphk2-Exos).These exosomes penetrated the annulus fibrosus(AF)and transported Sphk2 into the nucleus pulposus cells(NPCs).Sphk2 activated the phosphatidylinositol 3-kinase(PI3K)/p-AKT pathway as well as the intracellular autophagy of NPCs,ultimately ameliorating IVDD.This study provides a novel and efficient non-invasive combinational strategy for IVDD treatment using injectable ECM-Gels loaded with CESCs that express Sphk2 with sustained release of functional exosomes.

An updated diced cartilage fascia technique for dorsal augmentation in rhinoplasty

The aim of this paper is to discuss an updated technique for dorsal augmentation during rhinoplasty using diced cartilage wrapped in fascia. The usage of diced cartilage has been variously described in the literature with consistently satisfactory results. Herein, we present our experience with patients undergoing dorsal augmentation during rhinoplasty using an updated method of diced cartilage wrapped in fascia. Diced cartilage fascia techniques have become the technique of choice for dorsal augmentation for an ever-increasing number of rhinoplasty surgeons. The term is broadly descriptive and there remains a wide-range of ways to execute. Updating and enhancing the technique with greater attention to precision, and creating an aesthetically optimal and predictable result, may result in even improved outcomes for future patients.

Endoscopic-assisted rib cartilage harvesting for revision rhinoplasty

We describe the endoscopic-assisted rib harvesting technique for secondary rhinoplasty as minimum-invasive and safe harvesting method.Endoscopic-assisted rib harvesting was performed on 52 patients for revision rhinoplasty in last two years(2017-2019).Adequate amount of cartilage was obtained through 1-2 cm incision.The 30 degrees angled endoscope was used for vision control.Fifty-two patients underwent rhinoplasty with costal cartilage harvested using endoscopic-assisted method.The length of the harvested cartilage blocks from the rib was 5±1.5 cm in average.There were no associated intraoperative complications.Postoperative complications were less than by the conventional rib harvesting technique:in all cases,no signs of pneumothorax or excessive bleeding were detected after surgery.The wound healed without significant scarring in 50(96%)cases.Two patients(4%)showed hypertrophic scar formation.Postoperative pain was evaluated by using Visual Pain Analog Scale retrospectively.Forty-eight patients(92%)scored 1.43±0.7 experienced no significant postoperative pain.Only 4 patients(8%)scored 4.1±0.8 and complained of slight postoperative pain.This technique provides an effective and less-invasive alternative for conventional costal cartilage harvesting with reduced complications risk and extended visualization.Patients benefit from an inconspicuous scar and reduced postoperative pain.Technique can be applied for revision and primary rhinoplasty and allows achieving reproducible aesthetically and functionally successful results with minimized risks.

Full retroauricular skin and fascia expansion in microtia reconstruction:a single center experience of 166 cases

Aim:Ear reconstruction is a challenge for plastic and reconstructive surgeons.The ear requires sufficient skin coverage and a three-dimensional(3D)cartilage framework.In this paper,the authors present their 10-year experience in microtia reconstruction using tissue expansion and an autogenous rib cartilage framework.Methods:Ear reconstruction was performed in 3 operative stages.During the first procedure,a 50-80 mL kidney or cylinder-shaped expander was implanted deep to the subcutaneous fascia of the retroauricular mastoid region.Over a period of 3-5 months,the expander was filled to a final volume of 80-110 mL.In the next operation,the retroauricular fascia was eliminated or reserved following expander removal,and the autogenous costal cartilage framework was placed below the expanded skin flap.At the third and final stage,the earlobe transposition,tragus construction and conchal deepening were performed.Results:A total of 165 patients(166 ears)were reconstructed using tissue expansion and an autogenous rib cartilage framework.Complications included hematomas in 3 cases,expander exposure in 8 cases,cartilage exposure in 6 cases,infection and cartilage resorption in 2 cases,exposure of steel wire in 4 cases,and aseptic seroma in 2 cases.Follow-up ranging from 3 months to 5 years showed that 159 patients were satisfied with the reconstructed ear including size,location,projection,convolution,skin-colour matching,symmetry with opposite ear.Conclusion:Expansion of the retroauricular skin and fascia can provide sufficient non-hair-bearing skin and tissue for coverage of a three-dimensional costal cartilage framework.Avoidance and prompt treatment of complications are advised in order to obtain a satisfactory reconstruction of the ear.