Investigation of Two New Grafting Techniques for Dorsal Augmentation Rhinoplasty: An Experimental Study with New Zealand White Rabbits

Ozdemır M, Akkoç MF, Tunık S.

PubMed 38532200 Publisher (DOI)Free full text (PMC)

What this paper says

In 16 rabbits, fascia-wrapped diced tendon was the only graft of four tested that did not lose measurable volume, while diced cartilage alone gave the most irregular result.

Overview

Diced cartilage is often wrapped in fascia to hold it together, but harvesting both cartilage and fascia creates donor site problems. The authors tested whether skin dermis and tendon could substitute. Each rabbit received four different grafts implanted in four separate pouches on its back, allowing direct comparison within the same animal.

Sections of note

Design: animal experiment in 16 New Zealand white rabbits. No evidence level assigned, as it is a basic science study.
Four grafts per rabbit: diced ear cartilage alone, fascia-wrapped cartilage, dermis-wrapped cartilage, and fascia-wrapped diced Achilles tendon.
Diced cartilage alone had the most irregular appearance; fascia-wrapped tendon was smaller and softer.
Connective tissue formed between the diced pieces in all four, and the dermis and fascia formed a capsule-like layer while remaining viable.
Volume change was statistically significant for the three cartilage groups, p less than 0.05, but not for the fascia-wrapped tendon group.
More growth at the graft edges was seen in the fascia-wrapped and dermis-wrapped cartilage groups. The tendon group showed more scarring, fragmentation and collagen with less elastic fiber.

What it means for a patient

Wrapping diced cartilage in either fascia or dermis kept the graft smoother than cartilage alone.
Tendon held its volume best but was softer and showed more scarring under the microscope, so the trade off is between stability and tissue quality.
Dermis is presented as easier to obtain than fascia, which matters when both are taken through the same incision.
This is a rabbit study using grafts placed under back skin, not in a nose. Nothing here reports human results.

Why this paper matters

Shrinkage of diced cartilage grafts on the bridge is the recurring problem in augmentation rhinoplasty, and the wrapping material is one variable surgeons control. Comparing four options within the same animal removes differences in healing between subjects. Whether any of these behave the same way in a human nose is untested.

Terms

Diced cartilage: cartilage cut into tiny pieces so it can be molded like a paste.
Autograft: tissue taken from the same individual's own body.
Fascia: a thin sheet of fibrous connective tissue covering muscle.
Deepithelialized dermis: the deeper layer of skin with its outer surface layer stripped off.
Fibrosis: formation of scar tissue.

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

Abstract

Introduction: Cartilage is an important source in supporting the structure of the nose for dorsal augmentation rhinoplasty. However, it is known that its viability is not always on the ideal level. Various wrapping materials are used to increase the strength of cartilage. Donor site morbidity, which develops following the harvesting of both cartilage and fascia as one such cover material, has attracted interest in recent years.

Objective: In this study, we aimed to investigate the potential of dermis and tendon autografts as alternatives to fascia and cartilage.

Material And Method: The sample of the study included 16 New Zealand white rabbits. The right auricular cartilage of all rabbits was amputated, and it was transformed into diced cartilage autografts. The dermis autografts from the right gluteal areas of the rabbits were deepithelialized, and lumbosacral fascia autografts were harvested from the same incision. Additionally, the Achilles tendon of each rabbit was harvested and transformed into diced tendon autografts. Four different autografts were embedded under the skin of each rabbit from 4 different pouches opened in the back of the rabbit. These autografts included diced cartilage alone (Intervention 1), fascia-wrapped cartilage (Intervention 2), dermis-wrapped cartilage (Intervention 3) and fascia-wrapped tendon (Intervention 4) autografts.

Results: Intervention 1 had the most irregular appearance, the outcomes in Intervention 4 were volumetrically smaller and softer. Connective tissue formed between the diced pieces in all interventions, and it was observed that the dermis and fascia had a capsule-like appearance, and their viability was preserved. The differences between the initial and final measurements of the volumes of interventions 1, 2 and 3 were statistically significant (p < 0.05). There was no significant difference between the initial and final volumetric measurements of intervention 4 (p > 0.05). More peripheral proliferation was observed in the interventions of fascia-wrapped and dermis-wrapped diced cartilage compared to the other interventions. The intervention including fascia-wrapped diced tendon grafts had displayed more fibrosis, fragmentation and collagen fibers, while it showed a lower amount of elastic fiber. There were no significant differences among the intervention in terms of other histological parameters.

Conclusion: Tendon autografts may be a good option for dorsal augmentation rhinoplasty as they are easily harvested and have minimal donor site morbidity. Dermis autograft usage is more advantageous than fascia usage in terms of accessibility and convenience.

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