Rib Grafts in Rhinoplasty: A Systematic Review and Meta-analysis of Autologous, Fresh-frozen, and Irradiated Cartilage

Datta S, Ramly EP, Tucci V, Lees K, Hanna SA, Mattos D, Reish RG.

PubMed 42376269 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 25 studies and 2,322 patients, infection (1-2%) and warping (1-3%) were rare whether rib cartilage came from the patient, a fresh-frozen donor or an irradiated donor, while revision rates ranged from 1% (fresh-frozen) to 7% (autologous and irradiated).

Overview

Rib cartilage for rhinoplasty can be the patient's own (ACC), fresh-frozen donor (FFCC) or irradiated donor (IHCC), and their relative safety was unclear. The authors followed PRISMA, searched to April 2025, and ran random-effects proportional meta-analysis on infection, warping and revision.

Sections of note

3,109 records screened; 25 studies included: ACC 775, FFCC 1,076, IHCC 471 patients.
Infection 1-2% across all types, low heterogeneity.
Warping 1-3%, moderate heterogeneity among autologous studies.
Revision: 1% FFCC to 7% ACC and IHCC, with high heterogeneity and funnel-plot asymmetry (possible publication bias).
Post hoc power analysis supported non-inferiority of all types for infection and warping.

What it means for a patient

Donor rib cartilage was not more likely than your own rib to get infected or bend in the pooled data.
Fresh-frozen donor cartilage had the lowest revision rate, but that finding is the least reliable because the studies varied so much.
The choice can weigh the chest incision and recovery of an autologous harvest against the small uncertainties of donor tissue.

Why this paper matters

It is the largest pooled comparison of the three rib sources and finds comparable safety. Limits: observational studies, inconsistent follow-up, likely publication bias on revisions.

Terms

Autologous costal cartilage (ACC): rib cartilage from the patient.
Fresh-frozen cadaveric cartilage (FFCC): donor rib preserved by freezing.
Irradiated homologous costal cartilage (IHCC): donor rib sterilised by radiation.
Warping: bending of a cartilage graft after placement.
Funnel plot asymmetry: a statistical sign that small negative studies may be missing from the literature.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Costal cartilage (CC) is a widely used graft material in rhinoplasty, harvested from autologous (ACC) or cadaveric sources, such as fresh-frozen (FFCC) or irradiated homologous costal cartilage (IHCC). Although all graft types carry risks of infection, warping, and revision surgery, their comparative safety profiles remain uncertain.

Methods: A systematic review was performed in accordance with PRISMA guidelines. Multiple databases were searched from inception to April 2025 for studies evaluating outcomes of ACC, FFCC, or IHCC in rhinoplasty. Primary outcomes included infection, warping, and revision surgery. Data were pooled using random-effects proportional meta-analysis with heterogeneity assessed with I2.

Results: Of 3109 records, 25 studies (n = 2322 patients) met inclusion criteria (ACC = 775, FFCC = 1076, and IHCC = 471). Infection rates were low across all graft types (1%-2%), with low heterogeneity. Warping was similarly infrequent (1%-3%), though moderate heterogeneity was observed across ACC studies. Revision rates demonstrated greater variability, ranging from 1% in FFCC to 7% in ACC and IHCC, with high heterogeneity and funnel plot asymmetry. Post hoc power analyses supported noninferiority of all graft types with respect to infection and warping.

Conclusions: Infection and warping are rare complications across graft types, suggestive of comparable safety profiles. Revision outcomes appeared most favorable with FFCC but were limited by heterogeneity and study design. These findings are suggestive of comparable safety profiles among ACC and cadaveric CC grafts. Higher-quality, prospective controlled studies with standardized outcome reporting and follow-up time are required to better inform graft selection.

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