Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis

Overview

Rib cartilage taken from the patient is a common source of graft material when a nose needs substantial rebuilding, but it has long been criticised for bending after surgery and for problems at the chest site where it is harvested. No systematic review had tested those criticisms. The authors searched MEDLINE, PubMed and Embase for sources published from 1946 through June 2013 and pooled the eligible studies.

Sections of note

• Included studies had at least 10 patients and reported at least one long-term complication or donor-site problem.
• Excluded were nonhuman studies, reviews, case reports, abstracts, nasal reconstruction cases, donated rib cartilage, and diced or laminated methods.
• Two investigators extracted data independently using a standardised form. A random-effects model was used.
• Ten studies with 491 patients in total, mean follow-up 33.3 months.
• Pooled rates: warping 3.08 percent, resorption 0.22 percent, infection 0.56 percent, displacement 0.39 percent.
• Hypertrophic chest scarring 5.45 percent, pneumothorax 0 percent, revision surgery 14.07 percent. Level of evidence 4.

What it means for a patient

• Serious problems such as infection, graft movement or a collapsed lung were rare in the pooled data.
• The two issues worth discussing before surgery are the graft bending over time and a raised scar on the chest.
• About one in seven patients in these studies went on to have further surgery, though the reasons for revision are not broken down.
• The authors note few eligible studies and inconsistent definitions of complications, so the confidence intervals are wide and true rates may differ.

Why this paper matters

It puts numbers on objections that had been argued from experience rather than data, and it supports rib cartilage as a workable graft source for major nasal rebuilding. What remains unanswered is how these rates compare directly with ear or septal cartilage, and how they change beyond three years.

Terms

• Autologous: taken from the patient's own body.
• Meta-analysis: a statistical pooling of results from several separate studies.
• Warping: gradual bending of a cartilage graft after it is placed.
• Resorption: gradual absorption and loss of grafted tissue.
• Hypertrophic scar: a raised, thickened scar at the incision site.
• Pneumothorax: air leaking into the chest cavity, causing partial lung collapse.