Block and Surgicel-Wrapped Diced Solvent-Preserved Costal Cartilage Homograft Application for Nasal Augmentation

Abstract

Cartilage grafting has been used extensively to correct the nasal framework in traumatic and postrhinoplasty nasal deformities. Autologous cartilage grafts yield satisfactory reconstructive results, but their use is limited by donor-site morbidity, patient choice, the requirement for increased operative time, and the lack of a sufficient quantity and availability of tissue for more extensive deformities. Alternatively, preserved costal cartilage homograft represents a readily available, easily contoured material. The preserved costal cartilage homograft has been used by the authors on 68 patients over the past 5 years: in 52 patients with postrhinoplasty deformity and in 16 patients with traumatic nasal deformity. In cases with more severe nasal depression, the cartilage graft was carved and placed over the remaining septum in block form. The "Turkish Delight" technique, which was initially described by Erol, was used in cases of mild to moderate nasal depression. The cartilage graft was diced into 0.5- to 1-mm pieces. The diced cartilage mass was then wrapped in Surgicel and inserted under the dorsal nasal skin. Follow-up ranged from 6 months to 5 years. During this period, no major complications were noted, and satisfactory results were obtained. Recurrence of the dorsal depression was seen in five patients and required repeated augmentation. The complication and revision rates were acceptable. This technique seems to be effective for augmentation of the nose, shortens the operative time significantly by eliminating graft harvest, and avoids donor-site morbidity. Therefore, it is recommended for nasal augmentation and contouring for traumatic and postrhinoplasty nasal deformities.