Costal Cartilage Allograft Processing and User Patterns in Rhinoplasty

Vasudev M, Liu L, Lonergan A, Torabi SJ, Liu S, Ferreira MG, Tollefson TT, Wong BJF.

What this paper says

Among 41 certified US tissue banks the authors found 12 different ways of processing donor rib cartilage, and a survey showed 74.6% of rhinoplasty surgeons still use only the patient's own rib.

Overview

Donor (cadaveric) rib cartilage is an off-the-shelf alternative to harvesting a patient's rib, but reported failure rates vary, possibly because of how banks sterilise and preserve it. The authors reviewed public databases, patent records, PubMed and consulted scientists to characterise processing at American Association of Tissue Banks (AATB)-certified providers, and surveyed surgeons in the international Evidence-Based Rhinoplasty Reading Group about their preferences.

Sections of note

41 AATB-certified cartilage providers; 12 distinct proprietary protocols.
Gamma irradiation (1.0-5.0 Mrad) used in 63.6% of methods.
Peroxide-based detergents in 36.4%; alcohol-based detergents in 36.4%.
Antibiotic or aseptic solutions (bacitracin, polymyxin B, gentamicin) in 45.4%.
Surgeons who used allograft favoured fresh-frozen; 74.6% reported exclusive use of autologous rib.

What it means for a patient

"Donor rib cartilage" is not one product; it is processed in at least 12 different ways, which may affect how it behaves in the nose.
Most surveyed rhinoplasty surgeons still prefer the patient's own rib.
If donor cartilage is proposed, ask which bank and what processing (irradiated or fresh-frozen) is used.

Why this paper matters

It is the first systematic inventory of allograft processing methods and links that variability to inconsistent published outcomes. Limits: relies on public records and a survey of one reading group; no clinical outcomes measured.

Terms

Allograft: tissue transplanted from a human donor.
Autologous graft: tissue taken from the patient's own body.
Gamma irradiation: sterilising tissue with radiation, which can weaken cartilage.
Fresh-frozen: tissue preserved by freezing without irradiation.
AATB: American Association of Tissue Banks, the certifying body.

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

From the abstract

“Specific allograft processing methods may contribute to high failure rates. Objectives: To characterize commonly used proprietary costal cartilage allograft processing techniques among tissue banks and assess surgeon preferences for graft sterilization methods in rhinoplasty. Methods: A comprehensive review of…”

Excerpt; the full abstract is on PubMed.