Why Do Some Surgeons Store Excess Rib Cartilage Left over from Revision in the Scalp Area?

The reasons in favor of this are stated by other surgeons - reasons against it are that sometimes removal may be required due to presence of a hard lump and the fact that it is another incision with potential complications

Excess harvested rib cartilage can be "banked" within the scalp after a rhinoplasty procedure for possible use in the future.  The "banking" of cartilage provides a simpler means to harvest cartilage in the event a revisional procedure is necessary.  "Banking" is also more convient for the patient, allowing the patient a more comfortable recovery after cartilage harvest. 

This is called "banking" the cartilage. The scalp is used to store the cartilage because:


It may be needed at a later date so why discard it?

It is easier to place in the scalp then back in the donor site

It is easier to retrieve if needed at a later date

It is easily concealed under the scalp

the vascular supply to the scap is excellent

rib cartilage placed in the nose has a tendency to resorb

Storing excess harvested cartilage in the scalp behind the ear is done in case any revision (or refinement) procedures are needed in the future. The cartialge can be from any source, really, including the nasal septum. The idea is that it is much more straightforward to retrieve banked cartilage from behind the ear (if needed) than re-entering the nose or chest.

If there is a lot of left over cartilage (more likely with rib cartilage harvesting) I will also replace some of the cartilage back into the chest. Banking too much cartilage behind the ear can cause other problems.

Most surgeons only do this if they think that there is a reasonably good chance that further cartilage may be needed down the road.  The chances of this in your case are difficult to know; however, the scalp offers an area that is easy to access during rhinoplasty, isn't near the lungs (which could expose the patient to risk of a collapsed lung), and offers a good chance for survival of the cartilage (due to the high blood flow in the area).

Some surgeons store rib cartilage inthe scalp behind the ear just in case they  need to do another revision down the road. It is certainly easier to get the graft this way then to harvest another rib.

Dear Sac,  The technique of placing the residual rib graft cartilage in the scalp has been used for many years. This is used both in rhinoplasty and when rebuilding an ear from rib cartilage in microtia.  If you have gone to the trouble of having the rib harvested, then the most inconspicuous place to place your own potential future cartilage graft is in the scalp.  

The use of rib cartilage for rhinoplasty can be an excellent choice in certain circumstances.    If a person has undergone a previous septoplasty, then that cartilage source is not available for any necessary revision.  If the cartilage in the scalp bothered you in several years, it can be removed in a simple in-office procedure.

This is an unusual circumstance and likely related to the thought that further revision surgery will be necessary.  Placing the cartilage in the scalp offers a place with good vascularity, easy future access and reasonable cosmesis.