Outcomes of the Use of Fresh-Frozen Costal Cartilage in Rhinoplasty

Overview

Rhinoplasty becomes harder when there is not enough septal cartilage for grafts, and every alternative source carries drawbacks. Fresh frozen costal cartilage from a donor is an increasingly used option that the authors describe as carrying a lower theoretical risk than other choices. They reviewed the complication rates of Musculoskeletal Transplant Foundation material used in one surgeon's practice.

Sections of note

• Design: retrospective chart review, single senior surgeon, March 2018 to December 2021. Level of evidence therapeutic IV.
• 282 cases reviewed, all with a minimum of 12 months of follow up. Mean follow up 20.3 months.
• Mean patient age 35.8 years; 27 men and 255 women.
• 40 cases were primary rhinoplasties; 242 were revisions.
• 6 patients, 2.1 percent, required empiric antibiotics after surgery.
• No patient showed clinical signs of warping, resorption or displacement.
• 6 patients, 2.1 percent, required a further operation, which the authors state was unrelated to the donor cartilage.
• Stated conclusion: infection, warping and resorption rates were no greater than with the patient's own or other donor tissue.

What it means for a patient

• Donor rib cartilage avoids a chest incision, which is the main drawback of harvesting your own rib.
• Most cases here were revisions, where septal cartilage has already been used, which is the setting where donor material is most needed.
• Warping and shrinkage were assessed clinically rather than by imaging, so small changes would not have been detected.
• Limits: one surgeon, retrospective, no comparison group operated with the patient's own cartilage, and follow up averaging under two years.

Why this paper matters

Banked donor rib has spread quickly because it removes donor site pain and shortens operating time, but the durability question, whether it shrinks or bends over years, has driven the debate. A 282 case series with a year minimum adds substantially to the safety picture. Long term resorption beyond two years remains unmeasured.

Terms

• Fresh-frozen costal cartilage: donor rib cartilage preserved by freezing rather than chemical processing.
• Homologous tissue: tissue from another human, as opposed to the patient's own.
• Warping: bending or curling of a cartilage graft after placement.
• Resorption: gradual absorption and loss of graft volume by the body.
• Empiric antibiotics: antibiotics given for suspected infection before it is confirmed.
• Revision rhinoplasty: a second operation to correct the result of an earlier one.