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.
Answer: Advantages and Disadvantages of using Cadaveric Rib 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.
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Answer: Advantages and Disadvantages of using Cadaveric Rib 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.
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Answer: Grafts 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.
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Answer: Grafts 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.
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May 19, 2019
Answer: Cadaveric rib versus autologous rib 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.
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May 19, 2019
Answer: Cadaveric rib versus autologous rib 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.
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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: 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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