What are the disadvantages of using cartilage from a cadaver?

Over the past few years, I have been increasingly using cadaveric rib over donor rib. There is a lot of support in the medical literature that it generally survives and resorbs minimally.Obviously, there is morbidity (negative effects) associated with an incision and a harvest, especially one that is visible on the chest wall. Other concerns, such as pneumothorax (air around the lung) are very small, as it is an extremely uncommon complication. Also, when you harvest a rib, it then has to be carved and the carving is difficult to do precisely. Depending on how it is carved, it may increase the risk of warping over time.My preference has been to use cadaveric rib sheet. It is precut by the tissue bank in a perfectly straight piece. The risk of warping is significantly reduced by using the precut product. Most grafts, besides large dorsal augmentations, require thin and straight cartilage to work best (columellar strut, spreader grafts, rim grafts, etc.), so it is an optimal choice in my opinion. For large dorsal augmentations, patient choice dictates the donor source.

It is always best to use septal or ear cartilage.  For a soft area like the nasal tip, a rib cartilage is not as good an option.  If there are no options available, then rib then is a last resort.  

Cadaveric Rib has similar characteristics to ones own rib.  Its ideal in cases when a patient requires significant amount of donor cartilage but does not want to have their own rib harvested.  As with any rib graft the cadaveric rib can warp or resorb in a small percentage of cases. 

The concept of taking a piece of cartilage out of the freezer instead of harvesting it from your body is attractive. If you have sufficient septal cartilage, that should always be the first choice. If you need a lot more cartilage or have had a septoplasty, the alternative is ear or rib cartilage. Ear cartilage is thicker and softer. Using your own rib is considered state of the art, but it does involve removing a segment of your rib. If you are adverse to that, donor cartilage is a good alternative. In the medical literature, articles discussing if this cartilage will resorb or dissolve, the most recent article states less than 5%. Other older articles put this closer to 15%. If the cartilage does dissolve, the remaining scar tissue may not be strong enough to support the tip of your nose. 

I have spent many years looking into this subject and have written and lectured about this. I think most surgeons would agree that using the patient's own rib cartilage is the best solution but this comes with the additional issues of a small scar on the chest, increased operative time, postoperative pain and the very small risk of perforation through the chest wall into the lung when harvesting the rib cartilage.  There is also a well known risk of warping of the rib cartilage which is, perhaps, a little higher than when using cadaveric irradiated rib cartilage although there are ways of mitigating this risk. You have to balance those disadvantages against the slightly higher risk of absorption of the irradiated rib.  In my mind it also depends what the graft is being used for - I have less concerns using irradiated rib for structural purposes rather than building up (augmenting) the bridge of the nose.
Clearly using irradiated rib is more convenient but there are pros and cons and you need to make an informed decision with the advice of your surgeon.

The disadvantages of using cartilage from a cadaver are that in contrast to your own cartilage, the cadaver has only non-organic material. However, it works very well for the columella. It has a slightly higher risk of absorption than an autologous graft. 

Hello and thank you for the question. Cadaveric cartilage is an excellent source of cartilage grafting in revision rhinoplasty, where septal cartilage is not available. It is being used successfully with no major complication. I would suggest that you seek consultation with a board-certified plastic surgeon with experience in doing rhinoplasty, particularly revision rhinoplasty for more discussion. Best,

Rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
Cadaveric rib, as you say, can resorb over time but is usually replaced with scar tissue that does keep the overall structure in place. A columellar strut does not have any specific nuances when it comes to using cadaveric rib. 
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

Hi there - great question. The potential downsides of cadaveric irradiated rib graft include resorption and warping although both processes can occur with your own tissue too. In fact, warping may be reduced in cadaveric rib graft as it has had time to stabilise following harvest compared with your own rib. The advantages are obvious and include the fact that the surgeon can just focus on doing the best job on your nose and not waste effort on harvesting the rib. Good luck!

The main downside with irradiated rib cartilage is the fact that it is dead tissue and not living, viable cartilage as from your own rib.  This means that it will not become a living part of your nose, but rather will be placed by fibrotic tissue that will eventually resorb.  
For permanent results, your own cartilage (autologous grafts) is superior to any homologous grafts.