Analysis of the Physical Properties of Costal Cartilage in a Porcine Model

Lopez, Manuel A.; Shah, Anil R.; Westine, John G.; O'Grady, Kevin; Toriumi, Dean M.

doi:10.1001/archfaci.9.1.35

Cited by 38 publications

(28 citation statements)

References 15 publications

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“…1 This undesirable effect is minimized and theoretically eliminated by obtaining balanced cross-sections from the central core of the rib. 2-4 Such considerations demonstrate that the harvesting technique critically affects the shape dynamics and outcome of costal cartilage grafts, particularly in applications such as reconstructive rhinoplasty.…”

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confidence: 99%

“…Wong et al 7 developed a cartilage cutting guillotine using razor blades, in conjunction with securing the rib with gentle compression in a vise mechanism. Lopez et al 4 adapted the guillotine concept by using 4 parallel blades to obtain a central slice and 2 peripheral slices. Although these devices offer a simple and rapid cutting approach alternative to the traditional scalpel, the accuracy of these devices is not reported, and the literature is sparse with respect to reports of other devices.…”

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confidence: 99%

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Practical Device for Precise Cutting of Costal Cartilage Grafts to Uniform Thickness

Foulad

Manuel²,

Wong³

2011

Arch Facial Plast Surg

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Objectives Costal cartilage is becoming increasingly popular as a graft source for facial reconstruction. However, carving methods have not changed in decades and continue to primarily rely on detailed maneuvers with a scalpel. There are few reports of mechanical devices for shaping costal cartilage, and to our knowledge their accuracy and precision have not been reported. We describe a simple costal cartilage slicing device that facilitates the production of sections having uniform, user-defined thicknesses. Methods The design included laboratory research using 200 porcine and 2 cadaveric human ex vivo costal cartilage slices. A 2-component apparatus was constructed consisting of a mechanism to secure the costal cartilage and a double-bladed device to cut the rib graft through a central cross-section. Optimizing blade characteristics and static forces that secure the cartilage were critical design challenges. The device was used to obtain slices 0.8, 2.1, and 4.1 mm in thickness, with lengths up to 4.0 cm and a width of 1.0 cm. To confirm uniformity, thickness was measured at 8 fixed regions per section using a digital micrometer. Results All costal cartilage slices appeared to be extremely uniform on visual and manual inspection. The absolute difference between the largest and smallest thickness measured for each individual sample ranged from 0.04 to 0.13 mm, 0.06 to 0.14 mm, and 0.10 to 0.21 mm for the 0.8-, 2.1-, and 4.1-mm-thick groups, respectively. Conclusions Our study demonstrates the precision of using a mechanical slicing device to section costal cartilage to a clinically relevant and uniform thickness. This mechanized technology may increase accuracy and reduce carving time required for using costal cartilage tissue in head and neck reconstruction.

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confidence: 99%

Practical Device for Precise Cutting of Costal Cartilage Grafts to Uniform Thickness

Foulad

Manuel²,

Wong³

2011

Arch Facial Plast Surg

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“…2,8 As the graft gets thinner the warping tendency increases. 9 However, the rhinoplasty surgeon needs straight grafts in varying thickness. The costal cartilage graft of 1 to 1.5 mm thickness has the same tensile strength as the septal cartilage.…”

Section: Discussionmentioning

confidence: 99%

Oblique Split Technique in Septal Reconstruction

Taştan

Sözen

2013

Facial plast Surg

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The major obstacle for septal reconstruction surgery in the previously traumatized or operated septum is the availability of septal cartilage. A variety of materials, exogenous or autogenous, have been proposed for septal grafting. 1 Autogenous grafts, the more commonly used alternative, may be harvested from auricular conchal or rib cartilage. Often, extensive grafting is required necessitating a costal harvest. While costal grafts provide abundant cartilage they have a tendency to warp over time, which may translate into longterm failure for a septal reconstruction procedure. 2 A novel costal cartilage carving technique called "oblique split method (OSM)," introduced by the authors stands to eliminate warping by dividing the graft obliquely to provide equal circumferential forces of contracture. 3 In this article, this novel technique will be illustrated by the presentation of surgical technique and intra-and postoperative photographs of two patients (one open and one endonasal approach) operated for revision septorhinoplasty. MethodThe operation was performed in 69 patients. All had significant septal support problems due to previous surgery or nasal trauma. All of the septum reconstructions performed with the costal cartilage grafting. Seventh rib cartilage was used for grafting. An endonasal (n ¼ 21) or open (n ¼ 48) approach was used with the patient under general anesthesia. Appropriate informed consent was obtained. Surgical TechniqueMain purpose of our technique is to have straight, thin, adjustable, but durable costal grafts and reconstruct the nasal infrastructure suitably. 3 Superoinferior caliber of rib determines the length and anteroposterior caliber determines the width of the graft carved by OSM. Jung et al reported the seventh rib having the greatest anteroposterior caliber and length. 4 Therefore, a straight segment of the seventh rib is preferred; the right side is harvested for the surgeon's convenience. Around 3 to 4 cm of the rib segment is considered to be sufficient for any nasal deformity. A proximal and distal disc-shaped segment is excised from both ends of the rib segment according to the planned graft length. The over-and underlying perichondrium is elevated circumferentially and the costal cartilage is removed to be sculpted on the back table. A cross-sectional graft is obtained by splitting the rib AbstractThe septum is considered to be the most important anatomical structure in providing nasal support. Because of a variety of potential etiologies nasal septum could be severely deformed or even diminished. Autogenous cartilage has generally been considered the gold standard grafting material in reconstructive septal surgery for creating the infrastructure of the nose. In the restructuring of the nasal skeleton autogenous cartilage can be harvested from the auricle or the rib. For the major septal problems requiring a large volume of tissues with severe structural defects costal cartilage is considered the best graft material. Apart from its advantages, warping has been the main pr...

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“…10 Cyanoacrylate glue has been used as an alternative to sutures for the fixation of rib cartilage slices in a porcine model but was found to induce a strong foreign body reaction, resulting in partial resorption of the graft. 11 Homologous lyophilized bone has been used for dorsal augmentation. Radiographic cephalometry and fluoride positron emission tomographycomputed tomography demonstrated neovascularization and patchy osteoneogenesis, with a median loss of projection of 13% during the first 6 months after insertion.…”

Section: T He Quest For the Idealmentioning

confidence: 99%

The Diced Cartilage Glue Graft for Nasal Augmentation

Tasman

Diener²,

Litschel³

2013

JAMA Facial Plast Surg

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Background: A grafting technique that uses diced cartilage without fascia, which improves formability while maintaining long-term stability, would be a welcome addition to the rhinoplasty armamentarium.Methods: A diced cartilage glue graft was recently introduced as the Tasman technique. The technique has been used by one of us (A.-J.T.) in 28 patients who were monitored clinically for 4 to 26 months. Sonographic morphometry of the graft was used in 10 patients with a maximum follow-up of 15 months, and 2 biopsies were obtained for histologic examination.Results: Fashioning the diced cartilage glue graft reduced operating time compared with the diced cartilage fascia graft and allowed for a wide variety of transplant shapes and sizes, depending on the mold used. All grafts were used for augmentation of the nasal dorsum or radix and healed uneventfully. Sonographic cross-section measures of the grafts changed between 6% and -29% (median, -5%) in the early postoperative phase and 8% and -7% (median, -2%) between 3 and 15 months after insertion. Histologic examination of the graft biopsies revealed viable cartilage with signs of regeneration. Conclusion:The diced cartilage glue graft may become an attractive alternative to accepted methods for dorsal augmentation, the diced cartilage fascia graft in particular.

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Analysis of the Physical Properties of Costal Cartilage in a Porcine Model

Cited by 38 publications

References 15 publications

Practical Device for Precise Cutting of Costal Cartilage Grafts to Uniform Thickness

Practical Device for Precise Cutting of Costal Cartilage Grafts to Uniform Thickness

Oblique Split Technique in Septal Reconstruction

The Diced Cartilage Glue Graft for Nasal Augmentation

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