Safety and Efficacy of Non- and Minimally Irradiated Homologous Costal Cartilage in Primary and Revision Rhinoplasty

Overview

Donor rib cartilage is normally irradiated before use. This study asked whether cartilage that is not irradiated, or only minimally so, is safe and effective in rhinoplasty. The authors reviewed medical records from a single private practice for patients operated on between January 2010 and December 2014 by two senior surgeons. Twenty seven consecutive patients were identified and one was excluded for concurrent use of a synthetic material, leaving 26.

Sections of note

• Retrospective record review, single centre, two surgeons; 26 patients and 100 grafts.
• Seven patients had primary rhinoplasty and 19, or 73 percent, had revision rhinoplasty.
• Twenty, or 77 percent, were women; average age 42 years, median 45.
• Follow up ranged from 2 to 43.2 months, mean 15.9 months.
• Total graft related complication rate was 3.6 percent.
• Two cases of partial non infective resorption occurred among 77 palpable or superficial grafts, 2.6 percent.
• One infection occurred among 100 grafts, 1.0 percent; there were zero cases of graft mobility and zero cases of warping.
• The authors state larger studies are needed to determine whether reduced radiation improves outcomes over conventionally irradiated cartilage.

What it means for a patient

• Donor cartilage avoids a chest incision, since the rib is not taken from the patient.
• In this small group the failure rate was low, with resorption the most common problem.
• Twenty six patients and a mean follow up under 16 months cannot rule out late warping or resorption.
• There was no comparison group receiving conventionally irradiated cartilage, so the central question is unanswered.

Why this paper matters

Homologous rib is the alternative when a patient's own cartilage is unavailable or a chest scar is unacceptable, and irradiation is done to reduce immune reaction while possibly weakening the graft. This is the first clinical report the authors identify on the non irradiated version. Whether less radiation is better remains open.

Terms

• Homologous costal cartilage: rib cartilage from a deceased donor, processed for surgical use.
• Irradiation: radiation treatment of donor tissue intended to reduce immune reaction and infection risk.
• Resorption: gradual absorption and loss of a graft by the body.
• Warping: bending of a cartilage graft after placement.
• Revision rhinoplasty: an operation to correct the result of previous nasal surgery.