What are the disadvantages of using cartilage from a cadaver versus cartilage from your patient, specifically in regard to a columella strut graft? In regard to a columella strut graft, does cartilage from a cadaver resorb more frequently than cartilage taken from the patient? If it does resorb, will the remaining scar tissue keep the tip in place? Thanks.
May 8, 2019
Answer: Donor or Cadaver cartilage is an attractive alternative to your own cartilage but has a small chance of resorbing 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.
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May 8, 2019
Answer: Donor or Cadaver cartilage is an attractive alternative to your own cartilage but has a small chance of resorbing 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.
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May 8, 2019
Answer: Pros and Cons 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.
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May 8, 2019
Answer: Pros and Cons 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.
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