Harvesting Split Costal Cartilage Graft in Revision Rhinoplasty Without Disturbing the Costal Integrity

Overview

Grafts are unavoidable in some primary and secondary rhinoplasties where cartilage or bone is lacking, and rib is among the best sources but carries drawbacks. This study aimed to reduce the risks of taking a rib graft. Between 2018 and 2020, 21 patients aged 25 to 55 had revision rhinoplasty under general anesthesia using a split cartilage graft taken from the central part of the rib.

Sections of note

• Case series of 21 patients treated between 2018 and 2020; the journal assigns level of evidence IV.
• A 3 to 4 mm thick bridge of cartilage was left at both the upper and lower edges of the donor area.
• The graft was harvested from the central region so the continuity of the rib was not broken.
• A special retractor was placed between the perichondrium and the rib behind the costa to protect the pleura during cutting.
• Grafts were marked before cutting and harvested ready for use.
• The harvested cartilage was used as spreader, strut, alar rim and nasal valve grafts.
• No patient had a complication from the rib graft harvest.
• The author states donor site pain and painkiller requirement were less than in patients who had full layer grafts.

What it means for a patient

• Leaving the rib structurally continuous is intended to reduce chest wall pain and deformity after harvest.
• The comparison against full thickness harvest is described but no figures for pain or medication use are given.
• Twenty one patients from one surgeon with no stated follow up duration is limited evidence.
• The abstract does not report whether the thinner split grafts warped or failed in the nose.

Why this paper matters

Chest donor site pain is the main patient objection to rib grafting, and it drives some surgeons to donor or ear cartilage instead. This technique tries to remove that objection while keeping the rib as a source. Whether split grafts perform as well in the nose as full thickness ones is not addressed.

Terms

• Costal cartilage: cartilage from the rib.
• Split graft: a partial thickness piece taken without removing the whole segment.
• Perichondrium: the membrane covering cartilage.
• Pleura: the lining around the lung, which can be torn during rib harvest.
• Alar rim graft: a strip of cartilage supporting the nostril edge.