Augmentation Rhinoplasty with a Combination of Triple Cartilage Grafts for Secondary Rhinoplasty in a Middle-Aged Population

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault can cause a functional airway disorder, and the nose also may need a complete correction for cosmetic purposes. To achieve aesthetic and functional outcomes, augmentation rhinoplasty using a combination of triple cartilage grafts, namely, spreader, columellar, and dorsal onlays, was performed for 12 patients. Sufficient nasal airways with satisfactory appearance were achieved for 11 of 12 patients. Only one patient had improved but still insufficient nasal function with a good aesthetic result. Augmentation rhinoplasty using a combination of triple cartilage grafts for middle-aged patients could be considered an effective procedure for improving the patient’s nasal airway and appearance.     

Tragal Cartilage Grafts in Aesthetic Rhinoplasty

Ear cartilage is an important source of grafts for rhinoplasty. The majority of cartilage grafts is harvested from the concha of the ear. We describe indications in which the tragal cartilage is a more favorable graft source than conchal cartilage. The technique is fast, simple, and does not require special dressings.     

The Fate of Folded and Unfolded Dermal Grafts: A Histopathologic and Structural Study of Rabbits

Currently, both autogenous and nonautogenous materials are used to treat contour deformities. Autogenous grafts are preferable to nonautogenous grafts because they cause less reaction and are both inexpensive and easy to obtain. Currently, however, no consensus exists on an ideal autogenous graft. As autogenous materials, dermal grafts can be obtained from scar tissue, allowing simultaneous revision of scars, quicker vascularization than with other autogenous tissues, and a very short immobilization for their stabilization (i.e., they interact with surrounding tissues). The operation can be performed with the patient under local anesthesia, providing regular contours easily. Alternative techniques are needed to increase the viability and mass effects of autogenous grafts in the long term. With this as the objective, folded dermal grafts were used to increase the mass effects of dermal grafts. The current study compared long-term histopathologic and structural changes in unfolded and folded dermal autogenous grafts used for correction of soft tissue contour deformities. Thicknesses and histopathologic changes of the unfolded and folded dermal autogenous grafts were evaluated 6 and 12 months after placement of the grafts in the abdomens of 10 rabbits. Both the authors’ observations and histopathologic examinations showed that the folded dermis caused a more severe granulomatous reaction and fibrosis. Graft thicknesses considerably increased in the first 6 months, but then almost leveled off in the following months. Increased fibrosis in the folded grafts had a masslike effect, which was preserved in the long term, suggesting that folded dermal grafts can be used clinically.     

Cryopreserved Tracheal Grafts: A Review of the Literature

Cryopreserved tracheal grafts have been used in several experimental models of long segment replacement. The clinical application of the procedure has been limited due to the fact that contradictory results have been reported. The purpose of this article is to present a review of the literature on tracheal cryopreservation. Despite the fact that most authors indicate that cryopreserved tracheal allografts retain viability and have a low immunological response, though they continue to function after transplantation with good epithelialization and patency, cryopreservation leads to significant damage to cartilage, the degree of which is based on the freezing–storage methods that affect the function and durability of a graft. The long-term storage of cartilage must therefore be investigated in more detail in basic research models of cartilage viability: the evaluation of chondrocyte apoptosis, and the use of different solutions for tracheal cryopreservation other than RPMI-1640, Dulbecco's modified Eagle's, Eurocollins, and TC-199. Furthermore, problems that involve improving the blood supply to the graft after extensive resection and immunosuppression must be resolved before tracheal cryopreservation can become a clinically established method for tracheal grafts.     

培养软骨移植修复兔生长板陈旧性缺损

目的：将培养软骨移植修复生长板陈旧性缺损,防止肢体畸形发生,减轻畸形程度。方法：分离1月龄兔软骨细胞,经离心管内培养形成软骨。在6周兔右侧胫骨上端生长板造成缺损,4周后再次手术切除缺损内组织,植入培养2周软骨。左侧胫骨经相同处理,但无植入物,为自身对照。于4、8、12周行X线照片、组织学、免疫组化检查。结果：移植培养软骨4、8、12周时右侧胫骨畸形增加程度显著低于左侧,生长板缺损区由软骨组织充填,结构完整,Ⅱ型胶原免疫组化染色阳性。左侧胫骨畸形加重,生长板缺损区内骨桥形成,提前闭合。结论：培养软骨移植生长板陈旧性缺损,可以明显减轻肢体畸形程度,但不能纠正已发生畸形。     

Allogenous Cartilage Graft Versus Autogenous Cartilage Graft in Augmentation Rhinoplasty: A Decade of Clinical Experience

Cartilage grafts have great value in augmentation rhinoplasty. For most surgeons, an autogenous cartilage graft is the first choice in rhinoplasty because of its resistance to infection and resorption. On the other hand, an allogenous cartilage graft might be preferred over an autogenous graft to avoid additional morbidity and lengthened operating time. Allogenous cartilage grafts not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage grafts. The authors present their experience with 41 patients who underwent augmentation rhinoplasty using 22 autogenous and 19 allogenous cartilage grafts between June 1994 and August 2004. For evaluation of adequate augmentation rates, photographic analyses were performed on preoperative, early postoperative, and late postoperative photographs from all the patients. To assess patient satisfaction, the Facial Appearance Sorting Test (FAST) was applied preoperatively and late postoperatively in both groups. These results were compared, and it was concluded that in terms of resorption, there was no difference in the early and late postoperative follow-up data between allogenous and autogenous cartilage grafts. Evaluation of the preoperative and early postoperative photographic outcomes showed statistically significant differences with respect to adequate augmentation rates between the two groups. The FAST scores showed statistically significant differences between preoperative and late postoperative outcomes. There were no infections in the two groups of patients. Commentary to DOI: .     

Chondrogenesis in Repair of Articular Cartilage Defects by Free Periosteal Grafts in Rabbits

The origin of the cartilaginous tissue in articular defects after periosteal grafting was studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to artificial defects in the femoral articular cartilage. An isolating Nucleopore filter^®, hindering the penetration of cells, was placed between the graft and the cancellous bone, in order to trace the origin of the proliferating cells. The histological results revealed that the cartilage tissue which proliferated in the defect originated from the periosteal graft and not from the subchondral bone. The effect of the depth of the defect was studied by making a superficial and deep part in the defect. Cartilage tissue was found in both parts of the defect, though there was less in the more superficial defect.     

Reconstruction of Articular Cartilage Defects with Free Periosteal Grafts: An Experimental Study

The chondrogenic potential of free autogenous periosteal grafts was studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to 7 × 14 mm large artificial defects of the femoral articular cartilage. The results revealed that the defects were repaired and filled after 4 weeks with a hyaline-like cartilage which was histologically similar to the cartilage adjacent to the transplant. The tissue maintained this morphology after 1 year of observation. In control animals where no periosteum was transplanted to the defect, no real cartilage was found. The tissue which partially filled the defect was a variable mixture of fibrous tissue and fibrocartilage.     

Radiologic and Histologic Assessment of Diced Cartilage Grafts for Cranial Bone Defects of Rabbits: An Experimental Study

This study was performed to experimentally evaluate the viability and coverage of diced cartilage grafts for cranial defects. Biparietal bone defects were prepared in each of 20 rabbits. Otogenous bone grafts were fixed to one side, whereas cartilage grafts taken from the right ear, diced, and wrapped with oxidized regenerated cellulose (Surgicel) were placed on other side. Parenchymal impression, contour, and ossification of all grafts in the 16 rabbits surviving after 8 weeks were evaluated with computed tomography and magnetic resonance imaging. The existence of ossification was examined pathologically. Parenchymal impression was significantly more frequent in bone grafts than in cartilage grafts (p < 0.05). This difference probably is attributable to the application technique. There was no significant radiographic difference in other parameters between the two groups. No significant difference in ossification was found. In conclusion, ossification was seen radiologically and pathologically in diced cartilage grafts. Because of autogenicity, ease of shaping, absence of postoperative warping, reduced resorption rates, and inherent viability and ossification properties, the authors suggest that diced cartilage grafts may be an alternative material for cranial defects, especially for frontal cranial reconstruction in which deformities may cause aesthetic and functional disabilities. The authors believe that further long-term studies also are needed.     

Effects of Joint Motion on the Repair of Articular Cartilage with Free Periosteal Grafts

The effects of joint motion on the chondrogenic potential of free autogenous periosteal grafts were studied histologically in 6-month-old rabbits. The grafts were taken from the tibia and transplanted to artificial defects of the femoral articular cartilage. The joint was postoperatively first immobilized and then remobilized for various periods.

The results revealed that immobilization for 3 weeks had an inhibitory effect on the chondrogenesis, which was even more pronounced after 6 weeks of immobilization. After remobilization the chondrogenesis partially recovered. This recovery of chondrogenesis was more pronounced after 3 weeks' immobilization than after 6 weeks' immobilization. However, degenerative changes were observed in both series.     

自体骨膜延迟游离移植修复成年后关节软骨缺损的实验研究

目的：研究年龄对自体骨膜游离移植修复关节软骨缺损的影响,探讨延迟游离移植能否提高成年后骨膜修复软骨能力。方法：选中国白兔,成年兔20只,幼兔10只,分3组。A组：成年兔左膝骨膜直接游离移植组;B组：成年兔右膝骨膜延迟游离移植组;C组：幼兔骨膜直接游离移植组,取骨膜或骨膜新生组织、行光镜、电镜组织学观察比较。结果：移植前B、C组骨膜厚度、细胞计数及细胞活跃程度均优于A组（均为P＜0．01）,移植后12周3组关节软骨缺损获得不同程度修复,C组优于A组（P＜0．01）及B组（P＜0．05）,B组优于A组（P＜0．01）。结论：自体骨膜局部剥离、原位激活,体内培养、延迟游离移植可提高成年骨膜成软骨能力,更好地修复成年后关节软骨缺损。     

The Osteogenic Capacity of Free Periosteal and Osteoperiosteal Grafts: A Comparative Study in Growing Rabbits

The behaviour of free periosteal and 200 micron thick osteoperiosteal grafts was studied histologically in 40 six-week-old rabbits. The grafts were taken from the tibia and fixed on either side of the same lumbar vertebra between the spinous and mamillary processes. The free stripped periosteum had better osteogenic activity than the 200 micron thick osteoperiosteum. The new bone was formed by the osteogenic cells of the cambium layer in both types of graft.