Does K Wire Have to Always Be Used when Using Rib Cartilage Grafts for Rhinoplasty ?

Question

Does K Wire Have to ALWAYS Be Used when Using Rib Cartilage Grafts for Rhinoplasty ? I know that sounds like an odd question but I had to ask.

Ramin Behmand, MD, FACS · Answer

The essential benefit of a K-wire placed through the core of the rib graft (length-wise) is to prevent the graft from warping over time. One can also use K-wire to fix the graft in place or use any of the other methods described below. The main role of K-wire use is to prevent warping.

Ali Sajjadian, MD, FACS · Answer

Hello,

	As a quick answer, the K-wire is not a requirement when performing a rib cartilage grafting but some surgeons feel more comfortable using it to minimize possible warping of the graft.

	With that perspective, the skills of the surgeon of choice are the focal point when it comes to cartilage grafting during a rhinoplasty; the main idea is to obtain natural-looking commendable results with the ability to be sustained for years without delayed complications.

	That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.

	
	I hope this helps and please feel free to check the website below. 
	Thank you for your inquiry.
	The best of luck to you. 

	
	Dr. Sajjadian

Thomas A. Lamperti, MD · Answer

In short, K wire doesn't have to be used when placing rib cartilage grafting. Some surgeons utilize it more than others, but it certainly isn't a requirement.

Steven Goldman, MD · Answer

Rib grafts are most commonly used for revision rhinoplasty (nasal surgery on patients who have had prior surgery). They provide excellent structural support for the nose, but are well known to warp (bend) gradually over time. A K-wire is a surgical wire that can be inserted into the graft to reduce bending over time. Other techniques utilized to reduce warping include harvesting the mid-portion of the graft, crushing the cartilage, or dicing the cartilage into multiple small pieces that are usually wrapped in temporalis facia (connective tissue from the temple). Discuss the options and differences with your surgeon. Good luck.

Jonathan Kulbersh, MD · Answer

The K-wire is used to secure the rib cartilage in a desired location during a rhinoplasty.  Cartilage can be secured with sutures as well.  It is up the surgeon's preference which he prefers.  There are times when a K-wire is preferred.  In reconstructive rhinoplasties where major work is required to rebuild a nose from trauma or cancer a K-wire is the strongest option for support of rib cartilage to build a foundation.  

	
	I hope this helps!

Peter A. Aldea, MD · Answer

There are few occasions in Plastic Surgery when only one method is applicable. The fixation of Rib Cartilage Grafts in Nose surgery is no exception and the method of fixation depends on the specific circumstances and the preference of the surgeon. There is NO doubt that to assure a lasting pleasing result the graft should be fixated / its movement must be restricted. Depending on the circumstances, this can be used with a steel (Kirschner, K) wire, screw , plate and screws or even sutures. 

	Peter A Aldea, MD
	Memphis, TN

Michael L. Schwartz, MD · Answer

K wires for internal support and fixation of rib grafts is a technique popularized by the Dallas rhinoplasty group. It is very effective in solving certain problems of graft support and warping and is the way they found very helpful. Like many challenges in rhinoplasty other physicians have developed different techniques to handle these challenges. There is no absolute one way.

Robert Shumway, MD - Account Suspended · Answer

Think long-term! What will happen to Rib Cartilage/K-wire vs. smooth alloplastic silastic nasal implants? Rib and Auricular cartilage can and does warp or dissolve over time. In the right hands, even the nasal tip can be fashioned with extended dorsal silastic implants!

Francis R. Palmer, III, MD (retired) · Answer

I have performed Rhinoplasty for over 22 years and I don't recommend rib cartilage or bone grafts to build up the nasal bridge as they have a tendency to dissolve unevenly over the years IMHO. The wire is used, in these types of grafts, to secure the graft. I prefer using straight, silastic dorsal grafts to build up the nasal bridge and conchal cartilage ear grafts for the nasal tip. Both, of these grafts, are highly effective and reliable IMO.

Jay M. Pensler, MD - Account Suspended · Answer

A k wire is not used for a diced cartilage graft but is often used for a solid graft to the nose.

Does K Wire Have to Always Be Used when Using Rib Cartilage Grafts for Rhinoplasty ?

Answers (12)

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