Rib Cartilage Grafts - Stablized with Threaded K-Wire? (photo)

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

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

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.

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.