Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty

Özücer B, Dinç ME, Paltura C, Koçak I, Dizdar D, Çörtük O, Uysal Ö.

PubMed 28975239 Publisher (DOI)Free full text (PMC)

What this paper says

In 19 patients, harvesting rib cartilage by separating the muscle bluntly rather than cutting it with electrocautery gave significantly lower chest pain scores on multiple days out to 45 days after surgery.

Overview

Taking cartilage from the rib leaves the chest sore, and that donor site pain is a recognized drawback of using the patient's own rib. This prospective comparative cohort study, without randomization, compared two ways of getting through the chest muscle to reach the cartilage.

Sections of note

Controlled trial without randomization, conducted between January 1, 2016, and March 31, 2017.
20 patients enrolled; 1 excluded after an infection on postoperative day 7, leaving 19: 11 women and 8 men, mean age 33.2 years, SD 10.3.
Muscle-sparing technique in 11 patients using blunt dissection with a hemostat; muscle-cutting technique in 8 using monopolar electrocautery. All other surgical steps were identical.
Pain was scored on visual analogue scales for resting and movement pain at 8 time points: postoperative hour 6 and days 1, 2, 3, 7, 15, 30, and 45.
Resting and movement pain scores were consistently higher in the muscle-cutting group.
Significant differences for resting pain on days 2, 3, and 15, and for movement pain on days 2, 3, 7, 15, 30, and 45.
Analgesic infusion vials on day 2: 1.9 (SD 0.6) in the cutting group versus 1.0 (SD 0.9) in the sparing group, P .02. Level of evidence 2.

What it means for a patient

How the surgeon gets through the chest muscle affects how much the donor site hurts, including a month and a half later.
Pain on movement showed the more persistent difference, remaining significant at day 45.
The muscle-sparing group needed about half as many pain medication doses on day 2.
Limits: only 19 patients, groups of 11 and 8, not randomized, single center, and pain is self-reported.

Why this paper matters

Donor site pain is one of the main reasons patients and surgeons avoid rib cartilage in favor of implants or donor tissue. This identifies a modifiable step that reduces it. The sample is small, so the size of the benefit is imprecise.

Terms

Autologous costal cartilage: Rib cartilage taken from the patient's own chest.
Donor site: The place a graft was taken from.
Muscle-sparing technique: Separating muscle fibers bluntly rather than cutting through them.
Electrocautery: An instrument that cuts tissue using electric current and heat.
Visual analogue scale: A line on which a patient marks the severity of pain.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting.

Objective: To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery.

Design, Setting, And Participants: Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical.

Main Outcomes And Measures: Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used.

Results: The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02).

Conclusions And Relevance: Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain.

Level Of Evidence: 2.

Abstract as indexed by PubMed; the article is open access (PubMed Central).