Ultrafine Diced Rib Cartilage Graft with Minmal Incision On Chest for Rhinoplasty: Harvesting and Dicing Technique

Background: Diced rib cartilage grafting described by Erol¹ has been being used extensively in the world due to advantage of dicing ². However, traditional harvesting technique of rib cartilage has long scar, possible pneumothorax, and severe pain due to extensive dissection and resection of some rib cartilage. Therefore, scooping technique has been developed for harvesting of diced rib cartilage. Methods and materials:  July 2008 to Feb 2010 there have been 54 patients who had been performed by diced rib cartilage grafting for rhinoplasty. Using small incision on chest (1.2 to 2.0 cm), cartilage was harvested from just outer layer of costal cartilage with carving instrument using scooping technique. Harvested costal cartilage was diced into microparticulates about 0.2 to 0.5 mm² with cartilage dicer. This diced ultrafine particulates were put into modified 1cc syringe and inserted into nasal dorsal framework in each patient without surgicell and fascia coverage ³. Results: All patients were satisfied with donor aspects and recipient aspects except 2 patients who were suffered from inflammation on chest incision wound. However it was subsided with adequate dressing in a week after operation. There were no irregularity on dorsum due to ultrafine diced cartilage particulate.compared to traditional hand-made diced cartilage graft.  Incision length was 1.2 to 2.0(avg. 1.4 cm) and average harvesting time of cartilage was 12 min (9 to 17 min), and average amount of harvested cartilage was 1.35 cc(0.45 to 2.65 cc), and average volume of inserted cartilage was 0.8 cc. There was no pneumothrax due to outlayer harvest technique.    Conclusions: This technique could prevent possible pneumothorax, and it is safe technique due to being avoid pneumothorax, makes small incision with 1.5cm, minimize pain on chest significantly, minimize donor morbidity. We report our unique and simple harvesting technique of rib cartilage for rhinoplasty with satisfactory and safe result.

1

Fig 1 Harvesting Technique: scooping rib cartilgae with carving instrument with less than 2 cm chest incision.

Fig 2. Prinicple of scooping technique : harvesting outlayer of ribcartilge without potential risk of pneumothorax complication( 6^th rib cross section area)

Reference

1.       Erol OO. The Turkish delight: A pliable graft for rhinoplasty. Plast Reconstr Surg. 2000;105: 2229-2241; discussion 2242-2223.

..

2.       Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 2004;113:2156-2171

3.       Coskun BU, Seven H, Yigit O, et al. Comparison of diced cartilage graft wrapped in surgicell and diced cartilage graft wrapped in fascia: an experimental study. Laryngoscope. 2005;115: 668-671