Additional Rib Research Articles

Hospital-based study of cervical rib/ribs and its association with neurological complication

Introduction: Cervical rib is an additional rib which is the costal element of seventh cervical vertebra. Hence cervical ribs may first be revealed by nervous (particularly on eighth cervical and first thoracic spinal nerve) and vascular symptoms. Cervical rib is more often unilateral and somewhat more frequent on the right. In 90% of cases cervical rib probably causes no trouble. So the present study addresses the prevalence of cervical rib/ribs among both adult male and female and Radiological measurement of costal elements and its association with neurological involvements. Aim: the main aim of this study is to find out the prevalence and relation of length of costal process of 7th cervical rib with neurological symptoms among KPC Medical College outdoor patients. Methods: A prospective study has been carried out using technically adequate cervical spine AP and chest x rays PA view taken in department of Radiology, KPC Medical College and Hospital. Results: In this study all numerical and nonnumeric data of 495 patients has been plotted in Excel of Office 13. Observed 13 cases of cervical rib/ribs in which 7 were unilateral and 6 bilateral. Out of these 13 cases 12 cases had rudimentary cervical ribs.

Atypical articulation of the cervical rib and first rib.

The cervical rib is an additional rib arising from the transverse process of the seventh cervical vertebra. This rib may terminate free in soft tissue or may be attached to the first rib. The cervical rib is a congenital anomaly that occurs in less than 1% of the general population and sometimes causes severe symptoms of thoracic outlet syndrome. Hereby, we report a 13-year-old boy with an atypical articulation between the left seventh cervical rib and the left first thoracic rib.

Modified transmanubrial approach for complicated type 1 cervical rib resection requiring subclavian artery reconstruction.

The transmanubrial musculoskeletal sparing approach (TMA) is commonly used for resecting apical lung tumours with vascular involvement. Non-neoplastic conditions which might require surgical exploration of the thoracic outlet include the 'cervical rib', a clinical condition consisting of an additional rib forming above the first rib and growing from the base of the neck just above the clavicle. Type 1 cervical rib-when a complete cervical rib articulates with the first rib or manubrium of the sternum-is the most challenging scenario where the subclavian artery can be damaged by continuous compression due to the narrow space between clavicle, first rib and supernumerary cervical rib, requiring prosthetic reconstruction of the involved tract. Here, we describe a modified TMA in which the incision in the neck is conducted posteriorly to the sternocleidomastoid muscle, thus allowing safe dissection of the superior and middle trunk of the brachial plexus.

Bond behaviors of BFRP bars in concrete using carbon fiber rib anchorage

The geometry of Fiber Reinforced Polymer (FRP) reinforcement considerably affects the load-carrying capacity of structural member. Utilization of additional rib anchorage is expected to be the more effective approach to enhance the bond strength between basalt-FRP (BFRP) bar and concrete. In this paper, A total of 20 tested specimens (including 16 anchored specimens and 4 reference specimens) are fabricated to carry out direct pull-out tests. The influences of concrete strength, anchorage length and anchorage diameter on the bond performance of BFRP bar-to-concrete interface are investigated. Finally, an improved constitutive model is proposed to describe the pull-out behaviors of BFRP bars embedded in concrete using carbon fiber rib anchorage. Results indicate that the bond strength between BFRP bar and concrete can be significantly enhanced by additional rib, increasing by 17.0% compared with reference specimen. The proposed model includes fewer undetermined parameters than existing model, and its prediction accuracy is verified by the relative error ranging between 0.02% and 5.48% in comparison with experimental result. The enhancement effects of additional rib are sensitive to anchorage configurations, an additional rib with length-to-diameter ratio of 4.0 is suggested theoretically in this paper.

Management and outcomes of rib fractures in patients with isolated blunt thoracic trauma: Results of the Aotearoa New Zealand RiBZ study

AimRib fractures are common and associated with significant morbidity and mortality. There is limited literature on patient care and outcomes in Aotearoa New Zealand (AoNZ). The aim of this study is to describe key clinical outcomes and management interventions for patients with rib fractures across AoNZ. MethodsA national prospective multicenter observational cohort study was performed. Patients admitted between 1 December 2020 and 28 February 2021 with one or more radiologically proven rib fractures and an Abbreviated Injury Score of the head or abdomen of less than 3 were included. The primary outcomes of interest were the rates of thirty-day pneumonia, re-presentation and mortality. The secondary outcomes of interest were rate of surgical stabilisation of rib fractures (SSRF) and pain management of patients with rib fractures. Binomial logistic regression was performed for the primary outcomes and funnel plots were created of the inter-hospital variation in pneumonia. ResultsFourteen AoNZ hospitals and 407 patients were included. Mean age was 57.4 (SD 18.7), 28% were female, 15% Māori and 85% non-Māori. The median number of rib fractures was 4. The rate of pneumonia, re-presentation and mortality was 11%, 8% and 2%, respectively. Logistic regression found the odds of pneumonia increased with each additional rib fracture (OR 1.15 95% CI 1.05–1.25) and the odds of re-presentation increased with age (OR 1.028 95% CI 1.005–1.051) and Māori ethnicity (OR 2.754 95% CI 1.077–7.045). The funnel plot of inter-hospital variation in pneumonia rate adjusted for clinically plausible variables found no centre lay outside the 95% confidence interval. SSRF was performed in 2% of patients. 58% of patients had a pain team review and 23% a regional block. ConclusionThis study describes clinical outcomes for patients with isolated rib fractures from multiple hospitals in AoNZ. A moderate pneumonia rate of 11% was found which is likely amendable to reduction with quality improvement initiatives. Consideration should be given to further resource and improve the access to SSRF and regional analgesia given the low utilization found across AoNZ. A higher re-presentation rate in Māori and elderly patients was found which needs further investigation.

Incidence and Clinical Implications of Cervical Rib: A Retrospective Study

Introduction: Cervical ribs are an additional rib, which arise from the costal element of the seventh cervical vertebra. Incidence varies from 0.58-6.2%, incidentally detected on radiographs, but when enlarged can lead to various vascular and neurological symptoms. When it is of sufficient length it can compress the neurovascular bundle leading to Thoracic Outlet Syndrome (TOS) causing vascular and neurological symptoms. Aim: To determine the incidence and morphology of cervical rib in a convenient sample. Materials and Methods: A retrospective observational study was done in 650 radiographs (356 males and 294 females) from January 2016 to January 2019 and the study was conducted at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India, and the data was analysed for the incidence and morphology of cervical ribs. Results: Incidence of cervical ribs in females (1.7%) was higher than males (1.12%). In the present study, incidence of cervical ribs was 1.38%, we observed there were seven cases of bilateral cervical ribs and two cases of unilateral cervical rib. Morphologically, cervical ribs had head, neck and tubercle and articulated posteriorly with transverse process and no other significant morphological variations were seen. Conclusion: Knowledge regarding incidence of cervical ribs and other rib anamolies assists the radiologist and surgeons in early diagnosis and management of symptomatic patients in order to avoid neurovascular complications.

The fourth column of the spine: Prevalence of sternal fractures and concurrent thoracic spinal fractures

Study designRetrospective analysis. ObjectiveThis study aimed to identify the prevalence of concomitant thoracic spinal and sternal fractures and factors associated with concomitant fractures. Summary of Background DataThe sternum has been implicated in stability of the upper thoracic spine, and both bony structures are included in the stable upper thoracic cage. High force trauma to the thorax can cause multiple fractures to different upper thoracic cage components. MethodsThis is a retrospective analysis of electronic medical record data of patients treated at a Level 1 Trauma Center who underwent surgery for thoracic spinal fracture between 2008–2020. We recorded presence of concomitant sternal fracture, injury characteristics, hospital course data, and demographic information. Results107 patients with thoracic spinal fractures had a sternal fracture prevalence of 18.7%. The average age was 53.2 [15–90]. 72 (67.3%) were male and 35 (32.7%) were female, 92 (85.9%) were White, 10 (9.3%) were African American, 3 (2.8%) were Hispanic, and 2 (1.9%) were Asian. The average age of patients with sternal fractures was 48.7 years, compared to those without sternal fractures, 54.3 years (P = 0.251). Patients with T1-T7 fractures [14 of 48 (29.2%)] had a significantly higher rate of sternal fractures compared to patients with T8-T12 fractures [6 of 59 (10.2%)] (P = 0.012). Patients with additional rib (P < 0.001), scapula (P = 0.01), clavicle fractures (P = 0.01), and those with multiple other thoracic fractures (P = 0.01) had significantly higher rates of sternal fractures compared to patients without these. Patients with concomitant sternal fractures [10 of 20 (50.0%)] had a significantly higher rate of respiratory complication during their hospital course than patients without concomitant sternal fracture [40 of 87 (46.0%)] (P < 0.001). Sex, age, mechanism of injury, fracture morphology, estimated blood loss during surgery, intraoperative complications, post-surgical intubation status, and post-surgical intubation duration were not associated with sternal fractures. ConclusionsThe prevalence of concomitant thoracic spinal fracture and sternal fracture in our series is 18.7%. T1-T7 fractures and presence of rib, scapula, and clavicle fractures were significantly associated with the presence of sternal fractures. Presence of concomitant sternal fracture was significantly associated with respiratory complication during hospital course.

Conservative Management of Cervical Rib- A Case Report

Background: An additional rib that develops from the seventh cervical vertebra is known as a cervical rib, a congenital anomaly placed above the typical first rib, affecting 0.2- 0.5 percent of the total population. It may be seen on either the left or right sides. The majority of patients have little or no complaints and are identified by chance during an X-ray or CT scan. Due to the extreme compression on the arteries, veins and nerves caused by the position of the rib, which varies in shape and size, they might develop thoracic outlet syndrome. A cervical rib is a prolonged ossification of the lateral costal segment of the Cervical 7th vertebra.&#x0D; Clinical Presentation: A 18 years old female patient was diagnosed with cervical rib on X-ray due to persistent pain at right hand. Patient concern with reduced mobility of the right upper limb and unable to lift the hand. The patient went physiotherapy treatment which comprise of exercise and electro therapy for 10 weeks which resulted in improvements in pain and range of motion and functional activities&#x0D; Conclusion: The case report suggest that a prompt structured physical rehab let to improving the functional goals progressively and significantly which is a measured aspect leading to a successful recovery.

Using Computed Tomography skeletal surveys to evaluate for occult bony injury in suspected non-accidental injury cases - A preliminary experience.

This case series summarises our institution's preliminary experience of using computed tomography skeletal surveys (CT-SS) for the assessment of infants with suspected non-accidental injury (NAI) who were unable to undergo radiographic skeletal surveys (SS). This paper describes our experience using CT-SS in terms of radiation doses achieved, occult bony injury detection and forensic utility. Ten infants aged between two weeks and ten months underwent a CT-SS. The results of the CT-SS were compared with concurrent imaging results where available. Radiation doses from imaging procedures were calculated for each patient. Six infants had abnormalities identified on CT-SS. Two patients had both an ante-mortem CT-SS and post-mortem imaging. All fractures identified on alternate imaging modalities were visible on at least one CT-SS reconstruction. The radiation dose associated with CT-SS imaging ranged from 0.73 to 1.46mSv. The radiation dose received by the ten infants in this study was greater than the two skeletal survey approach but was less than the dose received during a bone scintigraphy examination, sometimes used to assess for occult bony injury in this setting. While CT-SS imaging results could not be compared with those obtained with current contemporaneous gold standard imaging techniques, CT-SS identified all fractures observed on the radiographic images where performed. CT-SS also identified additional rib fractures in two patients. Our preliminary findings indicate the need for future prospective studies to clarify the ability of CT-SS to detect metaphyseal fractures reliably.

Experimental Study on Seismic Behaviour of Angle Steel Connections with Concealed Corbel of Fully Assembled Frame Beam and Column

A method of “concealed corbel angle steel and bolt” is proposed to connect beams and columns of assembled frame. To study the seismic performance of the connection is designed an ordinary concrete beam specimen and three in the form of assembly connection specimens. The hysteretic curve, skeleton curve and ductility coefficient of cast-in-place specimen and angle steel connection specimen with concealed corbel are analysed by low cycle repeated load test. The influence of the angle steel thickness and the additional rib on the specimen in the assembly connection scheme is discussed. The test results show that: compared with ordinary cast-in-place concrete specimens, the assembly connection specimens have higher bearing capacity under the action of low-cycle reciprocating load. The hysteretic curves of the assembly and connection specimens were relatively full, and the displacement ductility coefficient was greater than 3.0, indicating that the assembly and connection specimens had good ductility. Increasing the thickness of the Angle steel and the additional ribs can improve the bearing capacity of the specimens. In particular, increasing the thickness of the Angle steel can significantly improve the bearing capacity of the specimens assembled and connected and reduce the damage of dark corbel before loading.

Application and Improvements of the Wing Deformation Capture with Simulation for Flapping Micro Aerial Vehicle

Wing deformation capture with simulation is a mixed experimental-numerical approach whereby the wing deformation during flapping is captured using high-speed cameras and used as an input for the numerical solver. This is an alternative approach compared to pure experiment or full fluid structure interaction simulation. This study is an update to the previous paper by Tay et al., which aims to address the previous limitations. We show through thrust and vorticity contour plots that this approach can simulate Flapping Micro Aerial Vehiclex (FMAVs) with reasonable accuracy. Next, we use this approach to explain the thrust improvement when an additional rib is added to the original membrane wing, which is due to longer duration for the new wing to open during the fling stage. Lastly, by decreasing the number of points and frames per cycle on the wing, we can simplify and shorten the digitization process. These results show that this approach is an accurate and practical alternative which can be applied to general bio-inspired research.

Feasibility of bilateral internal thoracic artery harvesting using the da Vinci SP system.

We conducted this study to investigate the feasibility of mobilizing the bilateral internal thoracic arteries (ITAs) using the da Vinci SP through a single intercostal incision and to compare the amount of rib spreading with that required for mini-thoracotomy procedures. We also evaluated the construction of an intrathoracic T-graft anastomosis using existing instrumentation of the SP system. We harvested bilateral ITAs from two male cadavers via a single incision made in the fifth intercostal space using the da Vinci SP. A T-graft end-to-side anastomosis was created in one cadaver. The bilateral ITAs were harvested in less than 60min and a T-graft was completed. No additional rib spreading was required. Intraoperative adjustments of the da Vinci SP were necessary to maintain alignment with the surgical targets. Bilateral ITA harvest using the da Vinci SP through a single intercostal incision was feasible, with less rib spreading than in mini-thoracotomy procedures. Thus, creating an intrathoracic T-graft with the existing da Vinci SP instruments is possible.

Autologous Costal Cartilage Harvest for Rhinoplasty with Simultaneous Breast Surgery: A Safe and Efficient Technique.

Autologous costal cartilage is frequently required for revision rhinoplasties and for challenging primary rhinoplasties. Patients undergoing a concomitant breast surgery can have costal cartilage harvested through their breast surgery incisions, thereby obviating an additional rib harvest scar. The safety and efficacy of this approach has yet to be described. The aim of this study was to evaluate the outcomes, safety, and results of a new technique, described here, for harvesting costal cartilage during a concomitant breast operation. Specifically, the rates of capsular contracture and rhinoplasty revisions were of great interest. A retrospective review was performed evaluating the senior author's experience with this technique. Data collected included patient demographics, operations performed, operative time, perioperative morbidity, and postoperative complications. Rates of capsular contracture and rhinoplasty revisions were compared with national averages. A total of 31 female patients were included. Ten (32.3%) breast complications occurred. There were 6 (19.4%) rhinoplasty complications, comprising 1 infection and 5 revisions. The capsular contracture rate was 6% and the rhinoplasty revision rate was 16%. Both of these rates are comparable to independent breast surgeries and rhinoplasties. There were no cases of perioperative mortality or major morbidity. Combining breast surgery and rhinoplasty surgery allows for autologous rib harvest through the breast surgery incisions. This is a safe technique that results in outcomes similar to either procedure performed alone. In addition, the patient is spared an additional surgery and donor site scar.

Improvement of bond performance between concrete and CFRP bars with optimized additional aluminum ribs anchorage

The slippage of fiber-reinforced polymer (FRP) bars in concrete occurs frequently because of the insufficient anchorage capacity of FRP bars in concrete, and it considerably affects the reliable application of FRP bars as reinforcing steel bars in civil engineering structures, especially in prestressed structures. In this paper, an optimized additional rib (AR) anchorage system was applied to the carbon-FRP (CFRP) bars to improve this weak anchorage characteristic of CFRP bars. The extrusion technology of the additional ribs was optimized, and only a slight deterioration of approximately 1.85% in the tensile strength of the CFRP bars was noted, compared to that corresponding to our previous extrusion technology (a loss of approximately 7.84%). Subsequently, pull-out tests were performed to investigate the influence of the number of additional ribs and bond length on the bond performance between the CFRP bars and concrete. The experimental results demonstrated that the existence of additional ribs, which produced an end pressure, transformed the bond stress transferring mechanism and reduced the radial force exerted on the surrounding concrete, thereby delaying the occurrence of the concrete splitting failure. In addition, the CFRP bars anchored with the additional ribs exhibited a remarkable enhancement in the pull-out strength, whereas this improvement was influenced by the embedment length of the CFRP bars and the ratio of the additional rib length to the bond length (lar/L). Finally, an empirical expression to calculate the development length of the CFRP bars with and without an AR anchorage was proposed and compared with the expressions provided in the existing design standards. It was concluded that the applied AR anchorage system could effectively reduce the development length of the CFRP bars. Compared to that of the control specimens, there was approximately 16.7% decrease in the development length for the specimens anchored with one additional rib.

Compressive behavior of hybrid double-skin tubular columns with a rib-stiffened steel inner tube

Hybrid fibre-reinforced polymer (FRP)-concrete-steel double-skin tubular columns (DSTCs) consist of an outer FRP tube and an inner steel tube, with the space inbetween filled with concrete. In hybrid DSTCs, the outward buckling of the steel inner tube is constrained by the surrounding concrete and the outer FRP tube, but its inward buckling is still possible. Existing research has shown that such inward buckling can become significant in non-circular hybrid DSTCs due to the non-uniform confinement, in hybrid DSTCs with a strong FRP tube due to the large axial deformation of the columns, and/or in hybrid DSTCs with a thin steel tube. In these cases, the stiffening of the inner steel tube is necessary to prevent or delay its inward buckling and to minimize its negative consequences to the column behavior. Against this background, a variation of hybrid DSTCs (hybrid R-DSTCs), in which the inner steel tube is stiffened by a number of vertical rib stiffeners, was recently developed at the University of Wollongong, Australia. This paper presents an experimental study on the axial compressive behavior of the new form of columns. The experimental program included a total of 12 R-DSTC specimens and two DSTC specimens for comparison, with the test variables being the number, thickness and width of rib stiffeners as well as the number of plies of fibres in the FRP tube. The test results confirmed that the additional rib stiffeners on the steel tube are effective in delaying the local buckling of the steel tube and in improving the performance of the columns. The test results also clarified the effects of the tested parameters of the rib stiffeners.

Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography (P=0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

High-speed deformation of a high-strength coated thin plate

The punch with cone-shaped working part impact into aluminum alloy thin-walled structures is mathematical modelled applying thermo-mechanical coupling of the physical processes during their deformation. The nonlinear physical properties contain a nonlinear stress-strain rate dependence of temperature. To solve the contact problem the sliding boundary conditions (friction) on moving bodies introduced. Numerical simulation of impact process performed using the finite element method and the independent Lagrange-Euler approach for two variants of the thin-walled box structure. The solution of the dynamic viscous plastic contact problem allowed to determine and to design the stress-strain fields in the thin-walled box section. For comparison, the deformation process of the similar aluminum construction with an additional rib considered when the punch with the conical working part impact. Analysis of stress-strain state for two various types of structural geometries demonstrated that mounting the additional medial rib into its design let redistribute the stress fields and significantly reduce the plastic deformation area during the impact because of four fold increasing in its contact stiffness. Such modification of the structure rigidity may improve the strength properties of the entire composite security device applying changes only to its part.

No breakpoint for mortality in pediatric rib fractures.

Rib fracture number correlates with mortality in adult trauma patients, sharply rising above six fractured ribs. Because of the pliability of younger ribs, pediatric ribs are believed to require more energy to fracture. We hypothesized this will result in a different rib fracture-associated pediatric mortality rate. We queried the National Trauma Data Bank (American College of Surgeons, Chicago, Illinois) for patients younger than 21 years with and without rib fractures (2002-2009), abstracting the number of rib fractures, diagnoses, procedures, and outcomes. Univariable and multivariable analyses were performed with logistic regression to adjust for age and concomitant injury. We identified 729,240 pediatric patients, 19,442 with rib fractures. Mortality doubled from 1.79% without rib fracture to 5.81% for one rib fracture and then nearly linearly increased to 8.23% for seven fractures unlike the pattern in adults. This pattern persisted irrespective of the age group evaluated. Ventilator days also increased with increasing number of rib fractures. Adjusted odds of mortality increased up to six rib fractures for all age groups. Penetrating injury, concomitant injury, and hemothorax all predicted mortality on multivariable analysis. More than two rib fractures also predicted chest tube placement (odds ratio [OR], thoracostomy 11.89 (11.37-12.44), thoracotomy 5.89 (5.17-6.84), thoracoscopy (6.28-12.03), laparotomy 2.68 (2.49-2.89). Mortality increased nearly linearly for increasing numbers of pediatric rib fractures without an inflection. Odds of mortality increases with each additional rib fractured in all pediatric age groups. Prognostic and epidemiologic study, level III.

Delivering multiple independent RIB simultaneously: Technical and operational challenges

ISAC is an ISOL-type facility at which RIB are produced by direct reactions of 480MeV protons from TRIUMFs main cyclotron on thick targets. Like other ISOL-type facilities, ISAC is limited to the production and delivery of a single RIB at any given time. ARIEL, the Advanced Rare-IsotopE Laboratory, will provide for the production and delivery of, ultimately, two additional RIB, the first produced by photofission on actinide targets using electrons from a new superconducting electron linac and the second by direct and indirect reactions with protons from TRIUMFs main cyclotron. This will allow for the simultaneous delivery of three independent RIB to experimental areas at ARIEL and ISAC.The shift from single-user to multi-user operation will introduce significant technical and operational challenges that RIB facilities have not yet had to address. Almost all aspects of facility operation will become more complex as the first RIB from ARIEL targets become available.

Satisfactory surgical option for cartilage graft absorption in microtia reconstruction.

We routinely perform auricular elevation at least 6 months after implantation of framework in microtia reconstruction using costal cartilage. However, in a few cases, cartilage graft absorption has occurred, which has led to contour irregularity with unfavorable long-term results. In the present study, we recount the details of using additional rib cartilage augmentation to achieve an accentuated contour in cartilage graft absorption cases. The cartilage graft absorption was defined as contour irregularity or cartilage graft deformation as evaluated by the surgeon and patient. Depending on the extent of cartilage graft absorption, another rib cartilage framework was added to the previously implanted framework, targeting the absorption area. We used banked cartilage or harvested new cartilage based on three-dimensional rib computed tomography. Additional recontouring of framework was conducted in eight patients who were examined for cartilage graft absorption from 1.5 to 5 years after implantation of the framework. Four patients received additional rib cartilage augmentation and tissue expander insertion simultaneously prior to auricular elevation. Two patients underwent auricular elevation simultaneously. In another two patients, additional rib cartilage augmentation was performed before auricular elevation. The mean follow-up period was 18 months, and in all cases reconstructive results were acceptable. Although further follow-up evaluation is required, additional rib cartilage augmentation is an attractive surgical option for cartilage graft absorption cases.