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Effects of Carving Plane, Level of Harvest, and Oppositional Suturing Techniques on Costal Cartilage Warping

Farkas, Jordan P. M.D.; Lee, Michael R. M.D.; Lakianhi, Chris B.S.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: August 2013 - Volume 132 - Issue 2 - p 319–325
doi: 10.1097/PRS.0b013e3182958aef
Cosmetic: Original Articles

Background: Cartilage warping has plagued reconstructive and cosmetic rhinoplasty since the introduction of extra-anatomical cartilage use. With the present level of knowledge, there is no evidence of the warping properties with respect to cartilage harvest and suture techniques and level of rib harvest. This report aims to improve understanding of costal cartilage warping.

Methods: The sixth through tenth costal cartilages were harvested from six fresh cadavers aged 54 to 90 years. Warping characteristics were followed with respect to level of harvest (i.e., sixth versus seventh), carving orientation, and oppositional suturing. Digital photography of the specimens was performed at various time points (immediately, 1 hour, and 1 month postoperatively).

Results: All specimens showed signs of warping beyond 1 hour of carving that continued in a linear fashion to 1 month. There was no statistical difference in the amount of warping specific to the level of harvest, orientation, or with or without oppositional suturing (p < 0.05).

Conclusions: Cartilage warping remains a problematic obstacle in nasal reconstruction and revision rhinoplasty, but costal cartilage remains the workhorse graft and is an excellent autologous option. Our findings are the first to be described in the literature regarding warping characteristics of costal cartilage with regard to the level of harvest, orientation of carving, and oppositional suturing techniques in a cadaveric model.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication September 24, 2012; accepted January 28, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jordan P. Farkas, M.D. Department of Plastic Surgery University of Texas Southwestern Medical Center 1801 Inwood Drive Dallas, Texas 75201

©2013American Society of Plastic Surgeons