The distortion of autogenous cartilage grafts: Its cause and prevention

Abstract

Summary 1.Autogenous cartilage as a grafting material for nasal bridge reconstruction has largely fallen into disuse because of the high incidence of distortion. An analysis of ninety-one of Professor T. P. Kilner's cases showed that about two-thirds warped to some extent within one or two weeks after operation, although the grafts had been freed from fibrous perichondrium before insertion. 2.Experiments in vitro demonstrated that in rib cartilage a state of tension exists in which the taut outer layer of cartilage acts as a skin which controls the tendency of the main mass to expand. 3.Distortion results from the contraction of the outer layer when the rib is so carved that the natural equilibrium is upset. In this the fibrous perichondrium plays little or no part. 4.The of the balanced has been introduced: if the distorting forces are balanced at all points along a cartilage graft as viewed in cross-section it will not warp. 5.Applying this principle, methods are detailed whereby stable grafts for nasal bridge reconstruction may be obtained. 6.Although the amount of carving permissible is limited, the shape and size of the costal margin cartilages are peculiarly suitable for nasal bridge grafts. 7.Forty-six grafts, carved according to the principle of the balanced cross-section, have been inserted during the past three years, and none has become distorted. 8.When used as described, autogenous rib cartilage is considered to be the material of choice in nasal bridge restoration.