The use of autogenous costal cartilage graft in septorhinoplasty

INTRODUCTION: Reconstructive septorhinoplasty in complex nasal deformities often requires harvesting a large amount of tissue for grafting. Autogenous septal cartilage has generally been considered the gold standard grafting material. The aim of this paper was to report our experience with the use of costal cartilage grafts in cases with significant structural deformities and insufficient septal cartilage. DESIGN: Retrospective chart review. PATIENTS: Between 1998 and 2006, 37 patients underwent septorhinoplasty using costal cartilage as the primary source for grafting. Twenty-two men and 14 women with a median age of 42 were enrolled in the study. Patient demographics, indications for surgery, and immediate and late complications were reviewed. The follow-up range was 3 to 72 months. CONCLUSIONS: Autogenous costal cartilage graft is a viable option in reconstructive septorhinoplasty. We advocate the use of this graft in septorhinoplasty cases requiring a large volume of tissue and insufficient septal cartilage.     

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.     

Two-stage reconstruction of the auricle in congenital microtia using autogenous costal cartilage.

The current authors reconstructed the auricles of congenital microtia patients with a two-stage method using autogenous costal cartilage. In the first stage, lobule rotation, fabrication of the cartilage framework, and implantation of the framework were performed. In the second stage, elevation of the auricle using transplantation of the costal cartilage and two local transposition flaps, formation of the tragus, and deepening of the concha were performed. A total of 125 consecutive patients were treated, ranging from seven to 53 years old, from 1990 to 2003. Sixty-nine patients were males and 56 patients were females. Unilateral microtia was present in 114 patients (right 73, left 41), bilateral in 11 patients. Ninety-four cases were the classic sausage-shaped lobule type deformity; the remaining 42 cases presented concha-type deformity. The follow-up period was 6 months to 10 years. One hundred and eighteen cases presented acceptable ear contour after ear reconstruction. Unfavourable results were blunted convolution of the reconstructed ear because of thick fibrous tissue in six cases, mild absorption of carved cartilage by infection in two cases, deformation of the constructed helix occurred in four cases, less projection of the elevated ear in three cases, and hypertrophic scars in three cases. Our procedure produced acceptable contour of the reconstructed auricle with fewer complications than conventional procedures. In addition, careful meticulous manipulation is necessary to create natural contour of the ear and to reduce complications in all stages.     

自体鼻中隔软骨移植鼻背延长术的临床应用

目的 探讨鼻中隔软骨移植治疗鼻孔显露的有效方法.方法 取鼻中隔软骨固定在鼻尖与鼻中隔前缘之间,延长鼻背,减小鼻唇角,同时修整鼻翼,改善鼻孔的形态.伴有鼻梁低平的患者,同期行硅胶假体隆鼻术.结果 本组共156例患者,术后均随访3个月以上,形态满意,其中2例因排异反应取出硅胶假体,6个月后再次置人硅胶假体,效果满意.结论 鼻中隔软骨移植鼻背延长术,其方法简单易行,效果可靠,值得临床推广应用.     

Large autogenous osteochondral graft for replacing knee cartilage defect

Summary Major cartilaginous defects of the femoral condyles of the knee joint, caused by chondropathy and chondral trauma can be a precursor to osteoarthritis.Particularly in cases with large defects the therapy often remains unsuccessful. Even the substitution of articular hyaline cartilage by autogenous osteochondral grafts, regarded as superior to other procedures like Pridies's drilling and abrasion arthroplasty, carries the risk of failure by necrosis of the craft and morbidity at the donor side.We present a 10-year follow-up case who had a large autogenous osteochondral graft from the non-weight bearing periphery of the patellofemoral joint that was implanted after necrosis of the medial femoral condyle following immunsuppressive chemotherapy.     

自体肋软骨充填矫治唇裂术后继发鼻畸形

目的 探讨对单侧唇裂术后继发鼻畸形,采用自体肋软骨移植,进行支撑结构矫正和重建的新技术.方法 对237例单侧唇裂术后继发鼻畸形患者,经微创切口采集肋软骨组织块,制备成C形软骨支架和软骨碎块,经开放式鼻小柱切口,于塌陷鼻翼内植入C形软骨支架,软骨碎块则充填纠正鼻翼基底下沉畸形.结果 237例单侧唇裂术后继发鼻畸形,术后手术切口优良愈合,鼻尖、鼻中隔和鼻翼畸形得到理想纠正,双侧鼻孔基底部等高,鼻腔通气功能好.1年后随访93例,鼻外形良好,无明显瘢痕形成.结论 采用自体肋软骨移植,对唇裂术后继发鼻畸形的硬组织畸形进行综合矫治,可以获得较理想的整形效果.     

先天性小耳畸形行自体肋软骨雕刻植入术的围术期护理

对12例先天性小耳畸形患者应用自体肋软骨做耳支架及乳突区皮肤覆盖分二期行全耳廓再造。术后随访6～18个月,再造耳廓皮瓣色泽红润,移植软骨支架无软化、吸收、变形,再造耳廓位置、形态、大小和对侧相似;拥有良好的颅耳角,患者对再造耳满意。提出术前做好患者及家属的心理护理,术后加强生命体征和皮瓣的观察,对保障术耳外形满意有重要作用。     

Repair of sheep articular cartilage defects with a rabbit costal perichondrial graft

A xenograft of costal rabbit perichondrium was trans-planted to an articular cartilage defect in a sheep knee. After 12 weeks, cartilage was formed with increased calcification of the basal layer and a mean of 74 percent collagen type II. the synovium did not show any infiltration, indicating the absence of any immunologic reaction.     

Multiple pellets expectoration: bronchial repair by using a costal cartilage graft

Foreign body expectoration resulting from penetrating thoracic injury is an extremely rare condition. It requires bronchoscopy for diagnosis, and if there is a bronchial wound with a large tissue defect, costal cartilage grafting covered with a vascularized muscle flap is suggested as a good alternative for the treatment.     

Repair of sheep articular cartilage defects with a rabbit costal perichondrial graft

A xenograft of costal rabbit perichondrium was transplanted to an articular cartilage defect in a sheep knee. After 12 weeks, cartilage was formed with increased calcification of the basal layer and a mean of 74 percent collagen type II. The synovium did not show any infiltration, indicating the absence of any immunologic reaction.     

Augmentation of the nasal dorsum with autogenous costal cartilage using the "edge-on" technique

Carved costal cartilage autografts are commonly used for nasal augmentation in saddle nose deformities. One major disadvantage of these carved grafts is postoperative warping. To prevent warping of costal cartilages, we used the "edge-on" technique. The inferior border of the cartilage is rotated 90 degrees to become the convex dorsum. No cartilage is trimmed or carved, and hence the intrinsic stress forces within the graft are not disturbed. The results in 21 patients are documented with long-term follow up (mean, 4 years) and showed no evidence of warping. Other complications, advantages, and disadvantages of the technique are discussed.     

Tracheal reconstruction with a prefabricated deltopectoral flap combined with costal cartilage graft and palatal mucosal graft

We have created an alternative method for tracheal reconstruction. Our new surgical procedure using a deltopectoral flap combined with a costal cartilage graft and mucosal graft for tracheal reconstruction allows us to achieve reconstruction of the tracheal mucosa, the tracheal cartilage, and the covering skin with adequate subcutaneous tissue. In one case, a tracheostenosis was reconstructed with a deltopectoral flap combined with a costal cartilage graft. In the other case, a tracheal defect was reconstructed with a deltopectoral flap combined with a costal cartilage graft and palatal mucosal graft. Although the operation is a multistage procedure, our method provides satisfactory clinical results. Thus, we believe that our method is useful for the surgical treatment of large tracheal defects.     

皮肤软组织扩张与自体肋软骨移植外耳再造术的护理对策

目的:总结皮肤软组织扩张与自体肋软骨移植法外耳再造相关护理的经验及效果。方法:2008年1月至2012年1月共收治耳廓缺损患者20例,其中先天性小耳畸形18例,外伤性耳廓缺损2例;手术方法:Ⅰ期耳后乳突区置入皮肤软组织扩张器,Ⅱ期利用扩张的耳后皮瓣及筋膜瓣覆盖自体肋软骨耳支架加皮片移植,形成再造耳,Ⅲ期行耳屏、耳甲腔等整形术。相应的护理对策措施主要有:围手术期的护理、心理护理、引流管的护理。结果:随访6个月~4年,均完成三期耳再造术,再造耳位置正常,形态良好,三维结构清晰,医患双方满意;未发生扩张器外露、感染、扩张器埋置术后血肿、软骨支架外露等并发症。结论:加强围手术期的护理和健康指导,可以减少并发症,是获得皮肤软组织扩张与自体肋软骨移植法外耳再造法手术成功的关键。     

Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty

Background:

Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. “Warping” can also be utilized to change the curvature of the graft.

Materials and Methods:

We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.

Results:

All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.

Conclusion:

The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.KEY WORDS: Autogenous cartilage, balanced section, costal cartilage graft, rhinoplasty, warping     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的临床应用

目的：通过应用自体肋软骨重塑鼻尖软骨支架结构,形成稳定的鼻尖软骨复合体,来达到完美、立体的鼻尖外形,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,从而达到理想的鼻部整形美容效果。方法：以鼻小柱基底部＂几＂字形切口和鼻孔内鼻翼软骨外侧缘切口,彻底分离皮肤达鼻翼基底部,对鼻尖短小朝天者可松解到达梨状孔边缘,显露两侧鼻翼软骨及侧鼻软骨,同时暴露鼻中隔软骨游离端;雕刻自体肋软骨,移植、固定到鼻中隔软骨上,贯穿缝合鼻翼软骨、移植的软骨,形成鼻尖软骨支架结构,构建鼻尖软骨复合体。雕刻膨体聚四氟乙烯或硅胶假体支架放置到鼻背鼻骨骨膜下抬高鼻背。结果：本组96例手术者均采用自体肋软骨移植构建鼻尖软骨复合体行鼻整形,术后7天拆线,切口Ⅰ/甲愈合。随诊6～12个月,95例术后鼻尖表现点明显,鼻形立体、挺拔,自然美观,鼻尖活动度好,效果满意。1例术者感觉鼻小柱下垂,通过修复移植软骨,达到满意效果。结论：应用自体肋软骨重塑鼻尖软骨支架结构,构建鼻尖软骨复合体,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,可以达到理想的鼻部整形美容效果。