What is your experience with permanent, threaded k-wires in rib cartilage grafts placed on the dorsum? Specifically, for those requiring significant augmentation (saddle nose or ethnic). Have you heard of, or experienced, extrusion of these wires, whether due to displacement of the graft, resorption, infection or other? Thank you in advance. Oh, and to the doctor who recommends silastic implants in all replies, please don't bother here. It speaks volumes about your experience.
Rib Cartilage Grafts - Stablized with Threaded K-Wire? (photo)
Doctor Answers 4
Extrusion of K wires
We have seen extrusion of K wires come out through the nose from a rib cartilage graft. Best to use nasal cartilage first before attempting to use rib cartilage
My experience is that threaded wires do not last; there are better ways
The threaded k-wire to stop rib warping seemed like a very good idea and many of us used it. However, the biological stresses in ribs are so strong that the rib can pull away from the wire, or even two wires. I have never had wires extrude, but have removed wires placed by other surgeons, even the best.
In a recent panel I said that I no longer use threaded k-wires. If the rib stays straight with the wire, it would have stayed straight anyway. I rely on different techniques and my experience to make the dorsal graft straight, and have found that works much better.
Rib Cartilage Grafts - Stablized with Threaded K-Wire?
The idea behind this, as you alluded to, is to stabilize and secure the somewhat unpredictable nature of rib cartilage with a rigid K wire. I've never used this technique but am aware of surgeons who do often. Concentric carving and patience will usually reveal the tendency of the rib cartilage to warp. Typically this gives enough information to reveal which pieces of cartilage should be used and how they should be positioned. Silastic implants do play a role but are used far more frequently in Asia.
Stephen Weber MD, FACS
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Rib onlay grafts
I have not heard of using K-wires to stabilize dorsal rib only grafts. One would expect that it would decrease the known resorption rate of these grafts, but add small risks of infection and extrusion. I find with saddle noses that structurally rebuilding the deficient dorsal septal strut and pulling up the upper lateral cartilages to the higher strut is a more permanent solution and also will improve the airway. Ethnic noses I use layered Gortex.