Immediate Reconstruction of Extruded Alloplastic Nasal Implants With Irradiated Homograft Costal Cartilage

Abstract

In this series of patients, a novel surgical protocol was used. The extruded implant was removed and immediate reconstruction with irradiated rib cartilage was done. All patients were evaluated for postoperative infection, graft extrusion, and satisfaction with cosmetic result. There was one major complication in this series of 18 patients, warping of the IHCC, which necessitated removal and replacement. This approach appears to be a reasonable method for reconstruction of extruded nasal alloplasts.

Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose

“…In 2002, Clark and Cook 44 reported successful application of IHCC for nasal reconstruction with only 1 case of warping. The sample size was 18 with a follow-up period of 13 to 48 months (mean, 30.5 months).…”

“…Only 1 patient had a complication, warpage, which required removal of the IHCC graft. 44 In the following year, Strauch and Wallach 45 reported on 130 IHCC grafts in 52 cases of rhinoplasties and 3 penile reconstructions. They reported 1 case of partial resorption during a follow-up period of 7 months to 12 years.…”

Salvage of Infected Cartilage Grafts for Nasal Reconstruction With a Through-and-Through Irrigation System

“…This increased infection rate is thought to relate to the diminished degree of tissue adhesion and implant incorporation seen in alloplast materials compared with their biologic counterparts. 1,5,8,12,[15][16][17][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Additionally, the simple presence of an implant foreign body in a wound can potentiate bacterial multiplication and propagation into a serious wound infection. 23,29,32,[35][36][37][38][39] Accordingly, grafting with autologous cartilage (or bone) is considered by many surgeons to be the preferred method for providing structural support in nasal reconstruction.…”

“…Several authors have successfully placed fresh autologous cartilage grafts immediately following the removal of extruded, infected, dorsal nasal implants. 21,27 Once an infection has become established in the nose, however, significant deformity can result from the progressive destruction of the underlying cartilage support. Aggressive intervention for eradication of the infection is mandatory for salvage of the reconstruction.…”

Complications in Rhinoplasty

“…23 Should an alloplastic implant extrude or become infected and require removal, immediate reconstruction with allogenic or autogenous rib has been successful. 24,25 Allogenic Grafts Allogenic grafts, sometimes called homografts, are tissue taken from another animal of the same species. Commonly used allogenic grafts in rhinoplasty include irradiated homograft costal cartilage (IHCC) and AlloDerm (LifeCell Corp., Woodlands, TX).…”