Rib Cartilage Used As Spreader Grafts - How Likely Are the Complications?

That bold statement is my personal observation after performing several hundred rib graft revision rhinoplasties. I find the strong straight pieces of rib to be excellent for rebuilding the bridge of the nose that has collapsed and formed an inverted "V" deformity after a rhinoplasty. We rarely see complications with the use of rib grafting. On a female the scar is nearly invisible as we place it in the same location as plastic surgeons use to place breast implants. The biggest patient complaint is soreness in the chest for several weeks after to cartilage is harvested. The most difficult part of the surgery is deciding how to carve the grafts themselves. One wants them to be large enough to correct the collapsed area without making the nose look too big or wide. I think that there is some resorption over time and I try to make the grafts slightly over large to compensate for this. 

I feel strongly about using only natural materials in the nose during rhinoplasties. There is less risk of extrusion and infection with natural grafts over the use of synthetic or non-living tissue grafts. We have a very high success rate with the use rib grafts in revision rhinoplasties. We have never had an infection, extrusion or warping when these grafts are used to correct inverted "V" deformities. 

I think the most important thing to consider when undergoing a revision rhinoplasty with rib grafts is the selection of an experience surgeon who can show you typical results with before and after photos.

Rib is a great source of cartilage for spreader grafts when septal cartilage is not available - ear cartilage is OK for correction of a contour deformity but lacks enough strength to correct a significant inverted V

Irradiated rib cartilage is procured from expired human donors and is irradiated to remove any causes for disease transmission or tissue rejection. Recently a long-term, landmark study was published describing the excellent reliability and consistency of irradiated rib grafts for patients who do not have enough septal cartilage and do not want to use their own ribs (see abstract link below).

Rib cartilage is a viable source of excellent cartilage for performing revision rhinoplasty.

Ear cartilage can be used as well, but ear cartilage is limited in how long of a spreader graft that can be made. Depending on how thick your spreader grafts would need to be, there may also be limits to how thick ear cartilage-based spreaders grafts can be made. The cartilage can be sandwiched to widened the graft. To get enough cartilage both ears may need to be harvested. With rib there is such an abundant supply that typically just one rib needs to be harvested.

Ear cartilage is weaker than septal or rib cartilage. I haven't found this to be as much of an issue with spreader grafts alone. However in revision rhinoplasty cases often the cartilage is used for more than just the spreader grafts. It is with these other uses that having strong cartilage is very important. I suspect that if two surgeons you've consulted with suggest rib, that is part of the reasoning.

Potential risks of rib grafting specific to that technique are injury to the lung during harvesting and warping of the the cartilage grafts. Lung injury is quite rare. You would want to make sure that your surgeon is board certified in facial plastic surgery or plastic surgery and has experience in harvesting and using rib cartilage for revision rhinoplasty cases. Board certification alone doesn't mean that the surgeon necessarily harvests rib or uses it for rhinoplasty very often.

The chance of warping can be minimized by using specific carving techniques. I have found that carving the cartilage incrementally over the course of a few hours (so warping can declare itself) allows for excellent results. If one needs straight cartilage the central core of the harvested rib is less prone to warping. If there are external deviations to the nose, however, one may want some curvature to the spreader graft to help straighten the nose.

 

The primary problem with the rib cartilage will be preventing it from warping. Otherwise it is an ecellent material to use in the nose. The list of complications are the same as any  other nasal procedure plus the risks of graft resorption and the ptoential donor site complications.

I would have few concerns about using rib cartilage for your revision rhinoplasty surgery, assuming you are healthy and have few medical problems.  The rib offers an area where an abundant amount of cartilage can be found and offers few side effects.  The potential complications from rib grafting include bowing of the cartilage and infection, but these risks are very unlikely.  Another quite unlikely, but serious complication, from rib grafting is a collapsed lung.  In addition, rib grafting can be quite painful.  I suggest a frank and open discussion with your surgeion about these concerns prior to proceeding.

Good Luck!

The inverted V deformity can be addressed through multiple techniques such as spreader grafts and osteotomies. It is better to have ear cartilage used as spreader grafts since there is much less trauma and complications that can occur with rib. Rib cartilage will tend to warp over time and make the nose very stiff. Another potential complication with a rib graft is the possibility of collapsing a lung when the cartilage is harvested from the ribs, in which case the patient will require a chest tube and hospitalization. Ear cartilage grafts are very useful for spreader grafts and work quite well.  

If you are having a revision rhinoplasty and you do not have enough septal cartilage to work with, rib cartilage is certainly a reasonable substitute.  There are also other choices like irradiated cartilage which is from a cadaver, or now a PDS product used for this procedure.

Any surgery has it own set of complications and risks.

Harvesting the rib cartilage graft has a small risk of entering the chest and a collapsed lung, which require a chest tube at worse.

Warling can be prevented by taking the graft frm the middle of the cartilage block, less warping forces.

Consult a BOARD CERTIFIED PLASTIC SURGEON ( AMERICAN BOARD OF PLASTIC SURGERY), THEY KNOW HOW TO HARVEST THE GRAFT