Harvesting the Entire Seventh Costal Cartilage for Secondary Rhinoplasty

Jung DW, Lee MJ.

PubMed 36148029 Publisher (DOI)Free full text (PMC)

What this paper says

Harvesting the whole seventh rib cartilage in 156 revision rhinoplasty patients took a mean 52 minutes and produced no cases of collapsed lung or other reported complications.

Overview

As rhinoplasty becomes more common, revision cases are increasing, and these require more cartilage than a first operation. Rib cartilage is considered a good source. The authors describe their method for harvesting the entire seventh rib cartilage, performed from April 2019 to March 2020 in 156 patients.

Sections of note

Technique description with a series of 156 patients.
The incision was placed in the fold under the breast in women and directly over the cartilage in men, about 3.5 cm long.
After the skin incision, the muscle fascia plane was found and wide dissection performed.
The fascia was opened and the rectus abdominis muscles split to expose the cartilage.
Careful dissection beneath the perichondrium was carried out all the way around.
The junction with the bone was cut and dislocated, then the joints with the sixth and eighth cartilages in turn.
The sternal end was cut last while protecting the underlying perichondrium.
The chest was checked for air leakage and closed in layers; mean harvest time was 52 minutes and average cartilage length 9.33 mm as stated.

What it means for a patient

The whole seventh rib cartilage provides the largest single piece available for rebuilding a heavily operated nose.
The incision is hidden in the breast fold in women.
No collapsed lung or other complications were reported in 156 harvests.
The stated average cartilage length of 9.33 mm appears inconsistent with harvesting an entire rib cartilage, so that figure should be treated with caution.

Why this paper matters

Revision rhinoplasty is limited by how much cartilage is available, and rib harvest is the main way to obtain enough. This series documents a method for taking the full segment with no reported chest complications. It reports nothing about how the cartilage performed once placed in the nose.

Terms

Costal cartilage: cartilage from the rib.
Perichondrium: the membrane covering cartilage.
Costochondral junction: where rib cartilage meets rib bone.
Synchondrosis: a cartilage joint between two adjacent rib cartilages.
Pneumothorax: air leaking into the chest cavity, which can collapse a lung.
Inframammary fold: the crease beneath the breast.

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

Abstract

Unlabelled: As rhinoplasty is becoming increasingly common, the number of revision cases is also increasing. These cases require more cartilage, and costal cartilage is considered a good material. We introduce a method of harvesting the entire seventh costal cartilage.

Methods: This study was performed from April 2019 to March 2020. The seventh costal cartilage was harvested from 156 patients. The incision was placed at the inframammary fold in women and directly above the cartilage in men. The length of incision was approximately 3.5 cm. After skin incision, we found a muscle fascia plane, and wide dissection was performed. We opened the muscle fascia and split the rectus abdominis muscles. Then, the seventh costal cartilage was exposed. Careful subperichondrial dissection was continued circumferentially. After the posterior aspect of the cartilage was exposed, the costochondral junction was cut and dislocated. The remaining perichondral dissection was performed under direct vision to avoid violating the perichondrium. Then, we dislocated the synchondrosis between the sixth and seventh cartilages and the seventh and eighth cartilages in turn. Finally, we cut the sternocostal area while protecting the underlying perichondrium and removed the cartilage. We checked for pneumothorax and then closed the wound layer by layer using 2-0 and 3-0 Vicryl sutures. Skin closure was performed with Steri-Strips.

Results: The mean time for cartilage harvesting was 52 minutes. The average length of the cartilage was 9.33 mm. No cases of pneumothorax or postoperative morbidities were noted.

Conclusion: We used sufficient amounts of cartilage to perform satisfactory rhinoplasty.

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