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: .     

The survival of costal cartilage graft in laryngotracheal reconstruction

Acquired subglottic stenosis in children is a difficult problem. One of the successful procedures used to correct this condition is an autogenous costal cartilage graft to the subglottis and upper trachea. The fate of the cartilage graft is not known, despite the good results of the procedure. Prompted by recovery of viable cartilage graft from two patients previously operated upon by this procedure, we performed autogenous costal cartilage grafting to the subglottic area of fifty young New Zealand rabbits, with inspection of these grafts at 2- and 4-month postoperative intervals. The purpose of this study is to prove the survival of autogenous costal cartilage grafts in the subglottic area. Gross and histologic examination 2 and 4 months postoperatively showed viable cartilage as well as lining of the graft with respiratory epithelium in the majority of cases.     

Comparison of AlloDerm, fat, fascia, cartilage, and dermal grafts in rabbits

OBJECTIVE: To compare various graft materials in the rabbit model, including autologous cartilage, dermal tissue, fat, and AlloDerm (a cadaver-derived material). METHODS: Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts. RESULTS: The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption. CONCLUSIONS: The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.     

自体鼻中隔软骨在鼻背凹陷充填术中的应用

目的 介绍用自体鼻中隔软骨充填鼻背凹陷的方法。方法 按常规鼻中隔矫正术切取鼻中隔软骨，根据鼻背凹陷的不同程度和部位，将充填软骨修削成单层卵圆形，或将软骨分割成2～3块叠加后缝合在一起，或将软骨制成倒“V”形，根据鼻背凹陷的大小和形状进行鼻背部充填。结果 43例患者短期效果全部满意，30例经6个月至5年随访，其中3例软骨有轻度吸收，鼻背稍凹陷，其余均较满意。结论 自体鼻中隔软骨充填鼻背整形，取材在同一手术野内完成，方法简便易行，软骨能与周围组织融合在一起，无排斥反应，长期效果较好，可作为鼻背美容整形的选择材料。     

Regeneration of the mandibular head from grafted periosteum

Grafted periosteum has a rich potential to induce heterotopic bone formation. In the current study the authors investigate whether autogenous periosteal grafts can regenerate the mandibular head in a rabbit model. They removed the mandibular head of Japanese white rabbits and grafted tibial periosteum to the cut surface of the mandible. Grafted periosteum was observed histologically and radiographically at day 7, 14, 21, and 45 after surgery. At day 7 after grafting, grafted tissue showed remarkable cell proliferation. By 14 days these cells had differentiated into chondrocytes to form cartilage, and endochondral ossification took place after 21 days. At 45 days after surgery, soft X-ray findings showed a newly formed mandibular head, which was similar histologically to that of a normal mandibular head. The cut mandible without periosteal graft showed no regeneration. These findings indicate that grafted periosteum can regenerate the mandibular head without special procedures such as bone fixation in a rabbit model, and suggest that this technique may be useful clinically.     

提高自体软骨移植物活性的研究进展

软骨移植物主要包括自体软骨、同种异体软骨、冷冻同种胚胎软骨、骨膜、软骨膜和生物材料等。但软骨移植存在许多缺陷,如供区继发性病变、进行性供区结构异常、移植物弯曲变形,移植物吸收与存活等问题。本文就提高自体软骨移植物活性的方法,包括软骨碎片或颗粒移植和包裹技术等进行综述。     

The versatile autogenous costal cartilage graft in septorhinoplasty

Secondary septorhinoplasty often requires a large amount of tissue, and autogenous costal cartilage is one type of grafting material that can be used in these cases. In this study, 20 patients with severe nasal deformity received autogenous costal cartilage grafts. Nineteen of the 20 cases were revisions. Costal cartilage grafts were used for structural and nonstructural purposes in these patients. Follow-up ranged from 8 to 32 months. The complications included 1 patient with early wound infection and 3 with minor warping. There were no problems with graft resorption or extrusion. Other than temporary pain, there were also no complications at the donor sites. We conclude that the autogenous costal cartilage graft is an outstanding material for volume filling and structural support when large amounts of tissue are needed in septorhinoplasty.     

The Effect of Epidermal Growth Factor on Autogenous Fat Graft

Autogenous fat grafting is widely used for the correction of soft tissue contour deformity. However, the high absorption rate results in the need for overcorrection, and graft longevity is unpredictable. The authors hypothesized that epidermal growth factor (EGF), a potent stimulator of neovascularization, would improve fat graft survival. The experiment used two groups of New Zealand White Rabbit ear. Inguinal fat was harvested and injected with EGF or saline (n = 24, each group). The 48 cases of fat grafting were managed for observation of volume and morphologic change. The fat was harvested 3 months after the autogenous graft. The survival rate and the degree of neovascularization were measured. The grafts in the EGF group had a significantly higher survival rate than those in the control group. Histologic examination of the grafts demonstrated an increase in neovascularization and maintenance of fat cell morphology. These findings show that EGF can enhance fat graft survival and degree of neovascularization. Further well-controlled studies are required before EGF is used for clinical purposes.     

Management and Aesthetic Results of Support Grafts in Saddle Nose Surgery

To define the surgical management and long-term aesthetic results of patients undergoing rhinoplasty with support graft for saddle nose, 147 patients have been included in this retrospective study. One hundred forty-four autogenous grafts (bone or cartilage) and three processed irradiated bovine cartilage grafts have been used during the period 1980–1997. Two approaches have been employed: open rhinoplasty and endonasal approach. Most of cases have been treated with bony grafts (116 bone graft versus 26 cartilage grafts). Global follow-up after surgery for long-term aesthetic study was 8.5 years. Among the different autogenous that have been used in our series, the calvarial bone had the most interesting results in terms of resorption. In patients with important saddle nose deformity, we recommend calvarial bone as a material of choice for dorsonasal reconstruction. It provides excellent and natural long-term feel to the nasal complex.     

冷冻保存胎兔颅骨骨膜修复关节软骨缺损的实验研究

为探讨关节软骨缺损的修复方法，采用家兔３０只，平均分成两组。在每个动物的双侧髌股关节股骨关节面作４ｍｍ×７ｍｍ全层软骨缺损。将经二步冷冻法保存的胎兔颅骨骨膜移植于一组动物一侧后肢作为实验组，另一侧用自体骨膜移植作为自体对照组。在另一组动物的一侧后肢用新鲜胎兔颅骨骨膜移植作为新鲜对照组，另一侧关节软骨缺损不修复作为空白对照组。术后肢体不作外固定。１６周后取材，经大体观察、组织学观察及氨基酸成分分析。结果发现，经冷冻保存的胎兔颅骨骨膜移植后能形成透明样软骨，与自体对照组无显著性差异（Ｐ＞０．０５），与新鲜对照组及空白对照组主要指标有显著性差异（Ｐ＜０．０５）。氨基酸分析示实验组新生物接近纤维软骨（Ｐ＞０．０５）。认为，冷冻胎兔颅骨骨膜移植为关节软骨缺损的修复提供了实验依据。     

The use of augmentation rhinoplasty techniques for the correction of the non-caucasian nose

To refine, enlarge, and enhance the mestizo nose, it is necessary to augment the structural support. The authors report on a series of more than 3000 patients over the last 20 years, exploring the possibilities of autogenous graft for augmentation of the nose. Their series showed minimal resorption of the bone grafts, no loss of volume of the cartilage grafts, and satisfactory long-term results.     

The protective effects of meniscal transplantation on cartilage. An experimental study in sheep

BACKGROUND: Meniscal loss may result in arthritis. The aim of this study was to establish a simple operative method for meniscal transplantation in a large-animal model and to determine whether meniscal transplantation provides protection of the articular surfaces, whether meniscal allografts have the same protective effect as meniscal autogenous grafts, and whether there is any rejection phenomenon associated with meniscal allografts. METHODS: Twenty-eight sheep were divided into four study groups, which were treated with (1) a sham operation (four sheep), (2) a meniscectomy (eight sheep), (3) a meniscal autogenous graft (eight sheep), or (4) a meniscal allograft (eight sheep). The meniscal transplant was secured with three suture anchors to the tibia. At four months after the operation, macroscopic and microscopic evaluations of the articular cartilage and the menisci of the sheep knees were performed in a blinded fashion. RESULTS: The group treated with the sham operation had no cartilage damage and had normal meniscal tissue. The meniscectomies resulted in significant macroscopic and microscopic damage to the articular cartilage in the medial compartment. The mean score (and standard error of the mean) for macroscopic damage to the cartilage in the group treated with the meniscectomy was 6.5+/-0.8 points compared with 3.9+/-0.7 points in the group treated with the autogenous graft and 4.3+/-0.6 points in the group treated with the allograft (p<0.05). The size of the area of damaged articular cartilage was reduced by approximately 50 percent in both groups treated with a meniscal transplant compared with the group treated with the meniscectomy (p<0.05). There were no significant differences between the group treated with the autogenous graft and that treated with the allograft. The histological appearance of the meniscal autogenous grafts was within normal limits. Interestingly, all of the allografts had evidence of fibrinoid degeneration with areas of hypocellularity and cloning of chondroid cells. CONCLUSIONS: These results suggest that meniscal transplantation provides noticeable although not complete protection against damage to the articular cartilage after a meniscectomy. The meniscal allografts were just as effective in providing this protection as were the meniscal autogenous grafts.     

The effect of fibrin glue on fat graft survival.

Autologous fat transplantation for filling defects or augmenting tissue is a common procedure but may have unreliable results. While fibrin glues lead to increased proliferation of fibroblasts and local accumulation of vascular endothelial growth factor, which enhances the neovascularisation, in this study the efficacy of fibrin glues on fat graft survival was investigated. Inguinal fat pads from Sprague-Dawley rats were harvested and same volumes of autogenous fat grafts were implanted into the separate pockets with the aid of fibrin glue (Group 1) and saline solution (Group 2). All the fat grafts were harvested, washed, blotted dry, and volumetrically measured with the same method used peroperatively at 6 months after implantation. Mean graft survival values for Group 1 were compared with Group 2 and histopathological evaluation of the grafts was also made. There was a significantly higher survival rate of the grafts in Group 1 than control group (79+/-4% and 55+/-6%, respectively). Histopathological examination of the grafts demonstrated evident increase in neovascularisation of the fat grafts in the experimental group. The authors conclude that the fibrin glue significantly diminishes the fat graft resorption and further well-controlled studies are required before using fibrin glues for clinical purposes.     

Study of rabbit septal cartilage grafts placed on the nasal dorsum

OBJECTIVE: To compare the reabsorption characteristics of fresh septal cartilage autografts, preserved homografts, and preserved autografts in the nasal dorsum of rabbits. METHODS: Rabbit nasal dorsum cartilage grafts were placed in 3 groups. The first group used fresh autologous cartilage; the second group, alcohol-preserved homologous cartilage; and the third group, alcohol-preserved autologous cartilage. Each rabbit received 2 grafts, one crushed and another noncrushed. After 16 weeks, the grafts were removed for analysis. RESULTS: No graft calcification occurred in any group. Chondrogenesis was observed in all groups. The fresh autograft group had the best results in the evaluation of the area of graft recovered and chondrocyte viability. The preserved autologous and homologous grafts did not differ in relation to any of the variables analyzed. Crushed grafts had inferior results in the area of graft recovered and chondrocyte viability compared with the noncrushed forms. No significant difference among the 3 groups was noted in the thickness of the fibrous capsule that developed around the graft. CONCLUSIONS: The fresh cartilage autograft was superior to the crushed and uncrushed preserved homografts and autografts; both types of preserved grafts had equivalent histological results. The uncrushed forms were superior to the crushed forms.     

An Animal Model for Small-Diameter Arterial Grafts

A rabbit model was developed to study small-diameter arterial grafts. A total of 158 2-mm-diameter polytetrafluoroethylene (PTFE) grafts und 35 autogenous carotid artery (AA) grafts were interposed in the carotid arteries of New Zealand white rabbits. A pilot study of 16 PTFE grafts used to develop operative and anesthetic techniques had a 20% mortality and 38% early (<2 day) thrombosis rate. Subsequent to the pilot study 177 grafts were placed and a 92% postoperative survival with 100% AA graft patency and 93% PTFE graft patency at 2 weeks was observed. AA grafts followed beyond 16 weeks continued to have 100% patency, while PTFE grafts began to show increased failure. Closure was found to be due to the development of anastomotic myointimal hyperplasia.     

Scar Tissue Graft as a Filler for Soft Tissue Augmentation

Soft tissue augmentation with autogenous tissue has been used to correct various defects during aesthetic facial contouring and reconstructive procedures. Although dermal grafts have longer survival rates, fat grafts always have been more popular because of the simple harvesting and grafting methods used. The authors aimed to use existing scar tissue as an injectable graft and to compare its effectiveness as a soft tissue filler substance with that of dermal grafts. In this study, scar tissue was created on 24 male Wistar rats. The created scar and normal healthy skin were removed from the rat dorsal scapular donor site. After depithelialization, the harvested tissues were minced until they were thin enough to pass through a 16-gauge needle. The grafts then were injected into the recipient site between the abdominal muscles. Volumetric analyses and histologic evaluation of the grafts were performed 1, 3, and 5 months after transplantation. The first month after the injection, the amount of remaining dermis graft was more than the scar graft, and this difference was statistically significant. However, at the end of months 3 and 5, there was no marked difference between the groups. The remaining volume of injected scar tissue graft was comparable with that of the dermis graft. The scar grafts were composed mainly of dense connective tissue during all the evaluation periods. In this study, scar tissue provided results comparable with those of dermal grafts up to 5 months when used as a soft tissue filler. It seems that neovascularization of the scar graft may be inadequate for maintenance of graft viability, as compared with dermis grafts. On the other hand, the scar graft formed fibrous tissue, which may be responsible for providing adequate volume as a filler. This may have clinical implications for the patient who needs both scar revision and soft tissue augmentation procedures simultaneously.     

Qualitative Histological Evaluation of Photooxidized Bovine Osteochondral Grafts in Rabbits: A Pilot Study

Photooxidation is a treatment that can render tissue less immunogenic and resistant to enzymatic degradation, while maintaining the mechanical properties of the material. The purpose of this study was to histologically examine the biocompatibility of photooxidized bovine osteochondral grafts when implanted into the rabbit. Two holes were drilled into the patellar groove of the rabbit knee. Photooxidized bovine osteochondral grafts were implanted into the holes. As a control, 1 surgically created hole in each rabbit was left to heal naturally. The animals were killed after 12 weeks. Histological analysis of the control sites indicated that fibrocartilage had begun to regenerate in the defect. Analysis of the grafts revealed a chronic, nonspecific inflammatory reaction. Active remodeling was observed in the graft bone, with "bridging" between host and graft bone evident. The articulating surface and majority of the graft cartilage remained undamaged. In a few instances, however, there was an inflammatory response to the base of the graft cartilage, near the subchondral plate. The surface of the graft cartilage was covered by a thin layer of fibrous tissue, and no viable chondrocytes were present. In most cases, there was no fusion between host and graft cartilage. The results from this study suggest that, while a biological reaction to the grafts occurred, the bone portion of the graft appeared to be in the process of remodeling, and the majority of the graft cartilage, most significantly the articulating surface, remained intact. Photooxidized osteochondral grafts show promise for use in the repair of osteochondral defects.     

Secondary rhinoplasty: management of the overresected dorsum

Any discussion of grafting the dorsum in secondary rhinoplasty must take into account the different indications (aesthetic, augmentation, and structure) as well as recent changes in materials and techniques (fascia, diced cartilage). We have placed solid dorsal grafts with diced cartilage grafts either as an isolated diced cartilage graft in fascia graft or as the aesthetic dorsal contour layer of a composite reconstruction. The rational for this profound change in selection and indication of dorsal grafts for revising the overresected dorsum will become clear as the various alternative materials and techniques are analyzed. Currently, we only employ autogenous tissues.