Reconstruction of Alar Nasal Cartilage Defects Using a Tissue Engineering Technique Based on a Combined Use of Autologous Chondrocyte Micrografts and Platelet-rich Plasma: Preliminary Clinical and Instrumental Evaluation

Abstract

Background:Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. The combined use of autologous chondrocyte micrografts and platelet-rich plasma (PRP) is an alternative that opens a new era in this field.Methods:At the Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy, 11 patients underwent nasal alar reconstruction with chondrocyte micrografts gently poured onto PRP in solid form. A computed tomographic scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate difference in cartilage density between native and newly formed cartilages.Results:The constructs of chondrocyte micrografts–PRP that were subcutaneously injected resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation.Conclusion:This report demonstrated that chondrocyte micrografts derived from nasal septum poured onto PRP in solid form are useful for cartilage regeneration in patients with external nasal valve collapse.

In Vitro and In Vivo Studies of Alar-Nasal Cartilage Using Autologous Micro-Grafts: The Use of the Rigenera® Protocol in the Treatment of an Osteochondral Lesion of the Nose

“…This construct, subcutaneously injected, resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. In addition, microscopic analysis of excisional fragments showed the persistence of healthy cartilage tissue with the formation of new capillaries penetrating into the cartilage as previously reported [29,30]. Here, we demonstrated that the Rigenera ® System is a useful method to isolate human chondrocytes when cells were injected with PRP in vivo in patients affected by nasal valve collapse and pinched nose deformity or cartilage defects.…”

“…Chondrocytes obtained were suitable to form autologous micro-grafts, which could be used alone or in combination with Platelet Rich Plasma (PRP) as published [29,30], and as reported in a patient analyzed in this work, to obtain a biocomplex ready to be implantable in subjects in need of such intervention. PRP was prepared with the approval of the transfusional service from a small volume of blood.…”

“…Using the Rigenera ® protocol, in just one surgical time, the patient is the donor and the acceptor of calibrated micro-grafts. Several authors demonstrated that: (i) Rigenera ® improves the healing of bone lesions as suggested by the use of micro-grafts obtained by periosteum in combination with collagen sponge [36]; (ii) Rigenera ® is effective in the process of wound healing, improving the superficialization of the wound and reducing wound size [25]; (iii) Rigenera ® opens new surgical strategies for rhinoplasty [29,30]. In this manuscript, we demonstrated with in vitro tests that micro-grafts isolated from murine and human auricular cartilage consisted of living single cells and clusters with mesenchymal properties.…”

Toward tissue-engineering of nasal cartilages

“…The use of IGF-I and GDF-5 increased the thickness of engineered neocartilage 12-fold over the untreated control [106] in scaffold-free nasal neocartilage engineered from human septal chondrocytes. Other stimulation regimens which increase the content of desirable matrix components and mechanical properties include the use of TGF-β3, BMP-14, platelet rich plasma, and subcutaneous implantation [90,114,115,118,119]. Culture of multilayered P1 human septal chondrocytes in a rotating bioreactor increased construct cellularity and GAG per wet weight content by 200%, as well as bulk modulus by 32.5-fold and elastic modulus by 22-fold of engineered constructs compared to static culture controls [105].…”

Tissue engineering applications in otolaryngology—The state of translation

“…(Figure 3). It is likely that the simplicity and low morbidity of cartilage‐only nasal grafts has created the opportunity for immediate investigation in human patients 9,20‐22 . The promising results from these studies have enabled investigators to initiate movement toward larger‐scale trials 9 .…”