Does Soaking Fresh Frozen Costal Cartilage in an Antibiotic Solution Reduce Postoperative Infection in Rhinoplasty?

Overview

Fresh frozen costal cartilage from a tissue bank has become popular for revision rhinoplasty and for primary cases lacking enough of the patient's own cartilage. No guidance exists on whether soaking the graft in antibiotic solution during surgery reduces infection. The authors reviewed one surgeon's practice between May 2017 and June 2022 to test that directly.

Sections of note

• Design: retrospective chart review, single senior surgeon. Inclusion required at least 12 months of follow up.
• 310 patients included, split into 200 whose grafts were soaked in antibiotic solution and 110 whose were not.
• Total infections: four, or 1.3 percent of all patients.
• All four infections occurred in the antibiotic soak group.
• The difference in infection rate between the groups was not statistically significant, p equal to 0.301.
• Statistical comparison used the Fisher exact test.
• Stated conclusion: soaking the graft in antibiotic solution during surgery does not reduce infection rates.

What it means for a patient

• Infection with banked donor rib cartilage was uncommon in this series, at about 1 in 77 patients.
• Soaking the graft did not lower that rate, so the practice appears to add cost and steps without measurable benefit.
• Four events is a very small number, so the study cannot rule out a small effect in either direction.
• Limits: retrospective, one surgeon, patients not randomly assigned to soak or no soak, and unequal group sizes.

Why this paper matters

Antibiotic soaking of implants and grafts is common practice across surgery, often carried over between fields without evidence. Testing it for banked rib cartilage in rhinoplasty addresses a specific habit. With four events, the study demonstrates the absence of a large benefit rather than proving no benefit exists.

Terms

• Fresh frozen costal cartilage: donor rib cartilage preserved by freezing rather than radiation.
• Musculoskeletal Transplant Foundation: a tissue bank supplying donor grafts.
• Antibiotic soak: immersing a graft in antibiotic solution before implanting it.
• Surgical site infection: infection occurring at the site of an operation.
• Fisher exact test: a statistical test suited to comparing small numbers of events.