Irradiated Cadaver Rib VS Autologous Rib Revision Rhinoplasty the Facts?

Question

I have some questions regarding Irradiated and Autologous Rib. 1. Can Irradiated rib grafts be pre-cut ( so that it is more predictable how the shape of your nose will be with the graft ) ? 2. Can Irradiated rib grafts easily survive for 10 years without resorping or loss of shape? 3. Is there a difference in warping? I've heard that Irradiated rib grafts doesnt warp as much as fresh autologous rib grafts. 4. Wich activities affect Rib grafts ( irradiated or Autolog ) and increase resorption

Douglas J. Kibblewhite, MD · Answer

The grafts are cut in the operating room to shape.  They have a tendency to curve or curl, but this usually occurs within about 15 minutes, so the cut bits are put in a saline bath while the surgeon prepares the nose for the graft.

	As long as the rib graft is firmly sewn into place so as to prevent movement, they seem to do well.  Rib grafts used as onlay grafts (not sewn in) are well-documented to variably reabsorb over 10 - 15 years.

	My practice has about 100 autologous rib cartilage nose patients, and about 400 tissue-bank rib nose patients, always used for structural work, and I have not seen a difference between them.  I do tend to recommend using one's own rib for significant problems in younger patients.

Jarrod Little, MD · Answer

Both irradiated and autologous bone grafts can be tailored before placement. Both types of bone grafts have a tendancy to resorb over time. This resorption continues for many years, and may never completely stabilize. The amount of resorption is difficult to predict. Many variables may increase the amount of resorption, including: infection, very thin overlying skin, multiple previous surgical procedures, general medical condition (diabetes, autoimmune diseases, etc.) and possibly whether an open or closed approach is performed for the rhinoplasty. Irradiated bone grafts are often preferred to autologous grafts to avoid the scar, deformity, and post-operative pain. Due to these issues and cost of the graft, I generally prefer autologous cartilage grafts from the nasal septum or the ear.

Francis R. Palmer, III, MD (retired) · Answer

Irradiated rib grafts as well as your own rib grafts, used in Rhinoplasty, both have tendency to dissolve unevenly over time.  I have had patients come to me for Revision Rhinoplasty that had these placed elsewhere and within 5 years they needed to be removed and replaced with a stable, straight silastic dorsal implant.  

	 You can do a literature search for rib grafts and Rhinoplasty to see the reported incidence.  IMHO, it's not work the risk using them as it's much more likely that another Rhinoplasty would be required in the not so distant future if they start to dissolve unevenly.

Richard Ellenbogen, MD (retired) · Answer

All rib cartilage irradiated or fresh absorb and warp. This is a fact and I can back it up with35 years of experience. One is not better or worse than the other. It is simply a disappointing fact.Discuss this with your doctor.

Irradiated Cadaver Rib VS Autologous Rib Revision Rhinoplasty the Facts?

Answers (4)

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