Oblique split graft technique avoids rhinoplasty warp

By Lynda Williams, Senior medwireNews Reporter

A novel graft technique may reduce the risk of costal cartilage graft warping in patients undergoing septorhinoplasty for saddle nose deformity with depleted source, Turkish surgeons say.

As reported in JAMA Facial Plastic Surgery, the team used an oblique cut across the long axis of the rib to create cross-sectional grafts of equal circumferential forces of contracture, thus reducing the risk for distortion.

Overall, 41 of the 43 patients treated with autogenous costal cartilage grafts carved using the oblique split method (OSM) reported satisfaction with both form and function, report Eren Tastan (Ministry of Health Ankara Training and Research Hospital) and co-workers.

One patient underwent further surgery for tip projection and a second patient required alar batten graft displacement surgery; both problems were attributed to inadequate preoperative planning and the graft was reused in the revision surgery.

None of the patients in the study experienced graft warping, infection, fracture, or resorption over an average 19.1 months of follow-up, report Tastan et al.

They explain that a 3-4 cm piece of rib was used to harvest grafts for a columellar strut, dorsal onlay, L-strut, lateral crural strut, caudal extension, or tip or speader grafts in primary (n=5) or secondary rhinoplasty procedures (n=38). The majority (n=34) of the procedures were open (n=34) and nine were endonasal.

The researchers say that OSM uniquely offers large volumes of straight, thin grafts suitable for septal cartilage-depleted patients.

"Costal cartilage grafts carved with the OSM provide grafts that are at the intended thickness, even 1 mm, and they preserve their straight form," they write. "The OSM grafts may safely be modified into a rectangular shape, carved asymmetrically, or have their edges beveled because they strictly preserve their straight form."

The researchers therefore conclude: "Current data from this study suggest that the OSM offers a flexible and reliable reconstructive option for the rhinoplasty surgeon."

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