7. Double-reversed Costal Cartilage Grafts

Abstract

PURPOSE: Costal cartilage provides the ideal graft for reconstruction of the nasal dorsum and tip given its abundant supply and flexural strength. Nevertheless, autologous costal cartilage grafts can be plagued by warping. Several techniques have been devised to offset the intrinsic warping effects of cartilage, but current techniques have several disadvantages. Herein, we present a multimedia demonstration of the double-reversed technique for costal cartilage reconstruction. METHODS: Patients with severe nasal dorsum defects undergoing nasal reconstruction with this novel technique by the senior surgeon over the past ten years were analyzed, and a detailed multimedia demonstration of this technique was produced. The technique is detailed in the submitted video. RESULTS: Sixteen patients with median age 20.0 years (IQR 18.8-30.7) underwent the described nasal framework reconstruction. Median operative duration was 142 minutes (IQR 115-179). Median duration of follow-up was 13.4 months (IQR 6.5-40.6). There was no observed warping, no noticeable graft resorption, and no displacement. All patients maintained tip projection. No patients experienced donor site morbidity. Aesthetic outcomes are demonstrated in the supplemental materials. CONCLUSION: The double-reversed technique for costal cartilage reconstruction is unique in its dual axis of rotation to offset warp in all dimensions. The technique can be performed with conventional instruments, does not introduce foreign material, and provides robust support to counteract the often scarred and contracted soft tissue envelope.