Diced Cartilage Grafts Research Articles

Viability and durability of diced cartilage graft combined and formed with autologous blood fibrin (experimental study)

<br><b>Introduction:</b> Rhinoplasty constitutes an example wherein the various types of filling materials are used for nasal dorsal deformities. In this study, we took the advantage of a simplified procedure and used fibrin isolated from the coagulated peripheral blood of the experimental animal. Durability and viability of diced autologous cartilage grafts adhered to each other and formed using fibrin extracts were assessed experimentally in a rabbit model. <b>Subjects and Methods:</b> Diced cartilage graft (Group 1), block cartilage (Group 2), and fibrin adhered 0.5 mm diced cartilage graft (Group 3) were placed into subcutaneous pockets in the frontoparietal region of the same experimental animal. The grafts were excised at the end of 16 weeks. The excised grafts were macroscopically evaluated, and the final volumes and weights were measured. These measurements were compared to the initial values before implantation. Finally, the specimens were evaluated the histopathological examination. <b>Results:</b> In Group 1, 165% increase in weight and 56% increase in volume; in Group 2, 131% increase in weight and 81% increase in volume; finally in Group 3, 184% increase in weight and 68% increase in volume were seen. Although histological examination did not reveal any difference with regard to chondroid matrix score, metachromasia, vascularization, fibrosis, and inflammation we observed significantly higher cartilage proliferation score in Group 3. <b>Conclusion:</b> The results indicate that these grafts can be used efficiently, particularly in rhinoplasty procedures to correct nasal deformities.<br>

Correlating the Volume of Diced Cartilage Grafts and the Gain in Nasal Dorsal Height Following Nasal Dorsum Augmentation

Background: Dorsal nasal depression can be correctedby various methods. In this study we aim to correlate theheight gain in the nasal dorsum with a fixed amount (1ml) ofdiced cartilage grafts wrapped in deep temporal fascia usedfor dorsal nasal correction.Patients and Methods: In this study included 14 patientswith dorsal nasal depression treated by one ml of dicedcartilage grafts wrapped in 20 X 40mm deep temporal fascialgraft. We correlated the gained height with a determinedamount of diced cartilage grafts.Results: The results were documented to correlate thegained height in the nasal dorsum. Results were evaluatedobjectively and subjectively.Conclusion: Our findings show that there is a correlationbetween the gained height of the nasal dorsum and the amountof diced cartilage grafts used in nasal dorsal augmentation.This preliminary finding needs further investigation on largerpatients' population and variable amount of cartilage graftsto validate these data.

Outcome of Free Diced Cartilage Grafts in Rhinoplasty: A Systematic Review.

Diced cartilage grafts are used to increase and refine the nasal contour, providing easy molding and versatility when compared with block grafts. However, all grafts present the possibility of visibility, distortion, and absorption. The aim of this study is to evaluate, through a systematic review, the outcome of the use of the free diced graft cartilage in rhinoplasty. A systematic search of the literature was performed in the databases (PubMed, Lilacs, Scielo, Cochrane) with the terms "diced cartilage" and "rhinoplasty." Studies were selected according to the inclusion and exclusion criteria and data extracted and grouped for analysis. Six eligible studies were included. In total, 4,044 patients underwent rhinoplasty with free diced cartilage graft, with 61 (1.51%) of them requiring reoperation. The main reasons were overcorrection and irregularities of the nasal dorsum. The infection rate was reported in three studies, with 2 (0.06%) of 3,252 patients presenting infection at the graft site. Two cases of displacement were treated with external molding, without reoperation. The graft resorption was reported in four articles, which described 22 (0.67%) cases of partial resorption in 3,288 patients. Therefore, the available evidence suggests that resorption of the graft and unfavorable outcomes are rare.

The Role of Skin Thickness in the Choice of a Rhinoplasty Technique for Thin-Skinned Patients: Analysis of Long-Term Results and Patient Satisfaction.

This randomized controlled study aimed to analyse the long-term results of thin-skinned patients who underwent rhinoplasty. All the included study patients had the following characteristics: underwent primary rhinoplasty for functional and/or cosmetic problems, were thin-skinned, had been followed for almost 2years, underwent both standard pre- and post-operative photography, had a good understanding of the Italian language, and had signed a consent form for inclusion in the study. The patients were randomly divided into 4 groups as follows: group 1, camouflage of the dorsum by diced cartilage; group 2, camouflage of the dorsum with lipofilling; group 3, camouflage of the dorsum by a temporal fascia graft; and group 4 (control group), without camouflage of the dorsum. Patients answered the Italian version of the FACE-Q rhinoplasty module. The Obagi skin pinch test was used to measure nasal skin thickness. We compared pre- and post-operative patient satisfaction with the appearance of their nose between the 4 patient groups by the Chi-squared test for unpaired data. Two plastic surgeons reviewed all the post-operative photographs of the study patients and rated the photographs on a scale of 1 to 5. A total of 101 patients who underwent primary rhinoplasty between January 2016 and March 2018 in our department of plastic surgery and satisfied the inclusion criteria were enrolled in this study. The mean patient age was 38.5years. The mean follow-up time was 2.5years. The differences between the preoperative and post-operative FACE-Q values for group 1 were significant (P < 0.01), whereas the differences between the preoperative and post-operative FACE-Q values for the other groups were not significant. The results for group 1 patients remained stable over the long-term follow-up compared with the results for other groups (P < 0.01). Groups 2 and 4 underwent more secondary procedures than groups 1 and 3 (P < 0.01). The 2 reviewers determined that patient groups 1 and 3 obtained more satisfactory outcomes than groups 1 and 4 (P < 0.01). This was the first randomized study to demonstrate that diced cartilage grafts used for thin-skinned patients was the best approach for obtaining a satisfactory long-term outcome and durable natural appearance. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison between Wrapping Dice Cartilage with Temporal Fascia and Wrapping in Alloderm for Dorsal Nasal Augmentation.

BACKGROUNDDorsal augmentation of the nose for aesthetic and reconstructive purposes is an important issue in rhinoplasty surgery. This study aimed to compare the two methods of dice cartilage wrapping for dorsal augmentation of the nose including temporalis fascia and alloderm.METHODSIn a clinical trial study, 50 patients who needed to augment the nasal dorsum, were enrolled and randomly allocated to two equal groups. In the first group, diced cartilage graft of the patient was wrapped in temporalis fascia and in the second group, a thin sheet of alloderm was used for this purpose. After one year follow up, satisfaction of patients and the expert panel were compared in two groups. Also mean increase in dorsal height was measured and compared in two groups.RESULTSThe mean increase of dorsal nasal height one year after surgery in the alloderm and temporalis fascia was 3.13±0.49 and 3.42±0.33, respectively and in the fascia group was significantly higher (p=0.02). The mean of patients’ satisfaction in the two groups of alloderm and temporal fascia groups was 7.48±0.92 and 8.04±0.89, respectively (p=0.03). The mean satisfaction of expert panel in the two methods was 7.56±0.81 and 7.7±0.63, respectively (p=0.5).CONCLUSIONThe use of temporal fascia for covering the diced cartilage in augmentation of nasal dorsum had better results than the alloderm. Patients satisfaction and mean dorsal height was higher in temporal fascia group.

The Effect of Perichondrium on Biological and Biomechanical Properties of Molded Diced Cartilage Grafts.

Diced cartilage is a significant alternative approach to cartilage grafting. However, the viability and biomechanical properties of diced cartilage grafts remain to be improved, and the role of perichondrium is largely neglected. This study aimed to evaluate the histological and biomechanical effects of perichondrium on custom-shaped diced cartilage grafts constructed via a high-density porous polyethylene mold. Seven New Zealand rabbits were used. Unilateral auricular cartilage was harvested and divided into 2 parts, with or without perichondrium, diced into 1 × 1 × 0.5mm cubical pieces, and filled into high-density porous polyethylene molds. Three grafts with the perichondrium removed and 3 with the perichondrium preserved were implanted subcutaneously at the dorsum. The grafts underwent biomechanical and histological tests 4, 8, and 12weeks after the implantation. The diced cartilage merged into integrated blocks without observable resorption in both groups at each time point. Additionally, the retention rate of weight was higher in the perichondrium-preserved group (P < 0.05). We observed regenerated cartilage that stained positively for type II collagen and glial fibrillary acidic protein (GFAP). A greater area of regenerated cartilage and higher scores of GFAP staining were observed in the perichondrium-preserved group (P < 0.05). The yield stress and modulus of elasticity were also higher in the perichondrium-preserved grafts from week 8 after implantation (P < 0.05). Diced cartilage grafts with a custom shape can be constructed using a high-density porous polyethylene mold. The preservation of perichondrium can improve graft viability and biomechanical properties. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Reconstruction Of Noe Fracture With Immediate Diced Costal Cartilage Grafting: A Case Series

&#x0D; &#x0D; &#x0D; &#x0D; Background : Naso-orbital-ethmoid (NOE) fracture is one of the common injury and the management remains difficult and controversial due to the anatomic complexity. Severe facial deformity and dysfunction are the results from the untreated injury. Moreover, the results from many procedures are not aesthetically satisfying. Meanwhile diced cartilage graft popularity is increasing in order to correct nasal deformity whether post trauma, revision (secondary) rhinoplasty or cleft nose. The procedure is less time consuming, easy to perform and also highly malleable.&#x0D; Methods : This study presents our experience in managing four patients with NOE fracture using costal cartilage graft technique immediately after injury. A columellar V-shaped incision was made, the finely diced cartilage harvested from the eight rib was injected to the glabella, dorsum and nasal tip using one cc syringe needle with cut tip. Demographic data were obtained from the patients’ medical record. Post-operative results were observed.&#x0D; Result: The four surgeries were done, with average 5.75 (range, 2-9) days after injury. During the observation, nasal tip misalignment was observed in only one patient. Diced cartilage were not visible through the skin, although it could be palpable. No cartilage extrusion were occurred. After averange follow up 10.25 mo (range 8-12 mo) All patients were satisfied with their facial appearance.&#x0D; Conclusion: The fracture of NOE can be manage with immediate diced costal cartilage graft, since this treatment can achieve a normal facial function and appearance. The complications are low and manageable, making it as serious contender technique of choice in managing NOE fracture to other techniques.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Keywords: NOE fracture, diced costal cartilage graft, facial fracture&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Dorsal Augmentation with Diced Conchal Cartilage Wrapped in Retroauricular Fascia.

Dorsal augmentation is of primary importance to shape an ideal nose. Although costal cartilage is still used for this purpose, diced cartilage grafts wrapped in autogenous fascia became more and more popular in recent decades. In this paper, the authors report their experience with a new combination made by diced conchal cartilage wrapped in retroauricular fascia in primary and secondary cases. The clinical records of the first 19 patients to undergo dorsal augmentation with this technique were reviewed. The entire concha has been harvested and, once diced, wrapped in a sleeve of retroauricular fascia obtained using the same incision. Quilting reabsorbable sutures closed the mastoid dead space and prevented the risk of hematoma. The graft has been used in all the cases through a closed approach. The use of diced cartilage is nowadays considered one of the best options among the available procedures for dorsal augmentation. Diced conchal cartilage wrapped in posterior auricular fascial graft is a new, simple and safe procedure that eliminates the necessity of a secondary donor site (temple or thorax), speeds up the operation and leaves a well-concealed scar behind the ear. Its main disadvantages toward costal diced cartilage wrapped in rectus abdominis fascia are the minor quantity of cartilage that can be obtained, even in case of bilateral harvest, and compared to temporal fascia a longer postoperative swelling (6-8weeks). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Free Diced Cartilage: Tips and Tricks of a Customized Procedure in Rhinoplasty.

Free diced cartilage graft represents a relatively innovative technique with multiple applications. It is conventionally used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. The aim of the article was to give some tips and tricks about harvesting and preparation of free diced cartilage to maximize its exploitation and make it easily repeatable, extending the field of application not only to the nasal dorsum but also other sites, such as the tip of the nose.

A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients.

Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18-43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.

Efficacy of diced cartilage graft in dorsal augmentation rhinoplasty and comparison with solid block cartilage

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study is to compare the results of dorsal augmentation rhinoplasty using diced cartilage graft wrapped in temporalis fascia and bare, solid block of cartilage.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of a group of 25 patients who presented to ENT OPD from January 2011 to January 2016 with saddle nose deformity. All the patients underwent external septorhinoplasty with dorsal augmentation using either diced cartilage wrapped in temporalis fascia or solid piece of cartilage harvested from septum or concha. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The patients were followed up for 18 months post-operatively and the results were recorded in terms of patient’s satisfaction. Complications, if any were also recorded.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Comparison between the two groups yielded equal success rate with no evidence of graft resorption, infection or extrusion in either of the group.&lt;/p&gt;

Porcine Mesothelium-Wrapped Diced Cartilage Grafts for Nasal Reconstruction.

Fascia-wrapped diced cartilage grafts have become a useful tool in modern rhinoplasty surgery. Unfortunately, fascial harvest is associated with donor site morbidity; therefore, a nonautologous alternative to fascia would be ideal. Decellularized porcine mesothelium (PM), Meso BioMatrix™, is an acellular scaffold that could potentially fill this need. To determine if PM could serve as an acceptable alternative, we histologically compared diced cartilage grafts wrapped in fascia versus PM. Human rib cartilage and temporoparietal fascia were obtained under an IRB-approved protocol. Cartilage was diced into 0.5 mm pieces and implanted in subcutaneous pockets in nude rats. Implanted materials included cartilage alone, cartilage wrapped in fascia, cartilage wrapped in PM, fascia alone, or PM alone. Specimens were harvested at 8 weeks and stained with hematoxylin and eosin, Masson's trichrome, Safranin-O, and Verhoeff's stain to assess cartilage viability, architecture, and regenerative potential. Unwrapped diced cartilage showed the highest cartilage viability, but was associated with loss of contour and dispersion of the cartilage pieces. Meso BioMatrix-wrapped grafts maintained contour and cartilage pieces had not dispersed; however, there was a significantly lower number of nucleated lacunae and a greater amount of basophilia than both fascia-wrapped cartilage and unwrapped cartilage. There was no significant difference in cartilage resorption between fascia-wrapped cartilage and Meso BioMatrix-wrapped cartilage or in the proteoglycan or collagen content between all groups. Off-the-shelf decellularized PM was associated with lower cartilage viability than unprocessed fascial allograft. No cartilage piece dispersion, fibrosis, resorption, or a foreign body reaction to Meso BioMatrix was observed. PM, although not equivalent to autologous tissue, may be utilized to achieve acceptable clinical results and be a viable alternative that limits donor side morbidity. This experimental study supports further clinical investigation of this material in rhinoplasty procedures.

Clinical assessment of solid cartilage versus diced cartilage in fascia in augmentation rhinoplasty

Objective The aim was to compare clinical outcome and fate of solid cartilage versus diced cartilage in fascia in augmentation rhinoplasty. Back ground Augmentation rhinoplasty can be achieved through many different techniques and materials. There are many different implantable materials available, both autologous and nonautologous. The major limitation of nonautologous material is the limited biocompatibility, which contributes to allergic reaction, excursion, displacement, and infection. Patients and methods This study was conducted in combination of Plastic Surgery and Burn Department of Mansoura University and Plastic Surgery Department of Menoufia University during the period from December 2012 to November 2015. It included 14 patients who underwent augmentation rhinoplasty, aged from 18 to 35 years, with mean ± SD age of 25.7 ± 6 years. In total, five (35.7%) patients were female and nine (64.3%) patients were male. Patients were divided into two groups. Group I underwent augmentation rhinoplasty by solid cartilage graft (septal, conchal, or rib). It included seven patients, with five (71.5%) male and two (28.5%) female patients, with mean ± SD age of 24.5 ± 6 years. Group II underwent augmentation rhinoplasty by diced cartilage graft enveloped in fascia (deep temporal fascia). It included seven patients, with four (57%) male and three (43%) female patients, with mean ± SD age of 27 ± 5 years. Results A total of five (35.7%) patients were female and nine (64.3%) of them were male. Overall, six (42.8%) patients underwent primary rhinoplasty, six (42.8%) patients secondary rhinoplasty, and two (14.2%) tertiary rhinoplasty. In group I, 43% of the patients had satisfactory (excellent) results, 14.25% of patients had intermediate results, and 42.75% of patients had unsatisfactory results. In group II, 71.5% of patients had satisfactory (excellent) results, 14.25% had intermediate results, and 14.25% had unsatisfactory results. Conclusion Diced cartilage graft is becoming a common place in rhinoplasty. The diced cartilage warped in autogenous fascia has good results, with minimal drawbacks, in comparison with solid cartilage.

Viability and Biomechanics of Bare Diced Cartilage Grafts in Experimental Study.

To assess the viability and biomechanics of bare diced cartilage grafts. Cartilage samples were collected from 1 ear in 15 rabbits as well as costal cartilage. Each rabbit was inserted bare diced- and single-strip costal-cartilage grafts, respectively, into paraspinal subcutaneous pockets: after euthanasia at 2 months, specimens were weighed, with diced cartilage grafts examined histomorphologically by hematoxylin-eosin staining, masson trichrome staining, and immunohistochemistry. Finally, biomechanical properties of grafts were assessed. Bare diced cartilage grafts were connected into an integrated mass after 2 months, and inward growth of fibrous tissues and angiogenesis were observed. Mean wet weights of diced cartilage grafts were 1.603 ± 0.278 and 1.662 ± 0.204 g pre- and postoperation, respectively; those of costal cartilage grafts were 0.053 ± 0.008 and 0.058 ± 0.008 g, respectively. In compression assays, mean modulus values of elasticity at yield in diced- and costal-cartilage grafts were 7.65 ± 0.59 and 22.30 ± 1.15 MPa, respectively (P < 0.05); mean stress values were 4.07 ± 0.38 and 12.50 ± 1.15 MPa, respectively (P < 0.05). In the tensile test, mean modulus values of elasticity at yield of diced- and costal-cartilage grafts were 4.70 ± 0.78 and 10.59 ± 1.39 MPa, respectively (P < 0.05), mean stress values were 0.82 ± 0.05 and 1.76 ± 0.21 MPa, respectively (P < 0.05). Diced cartilage grafts had favorable viability and growth. Despite reduced elasticity and stress values, they still can be served as substitute for supportive filling materials.

Discussion: Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty.

Discussion: Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty.

Effect of scopoletin on fascia-wrapped diced cartilage grafts

Purpose: To evaluate the effect of scopoletin (SL) on fascia-wrapped diced cartilage grafts in rhinoplasty surgery.Methods: Cartilage grafts (2 × 2 cm) from the ears of New Zealand rabbits were diced into sections (1 mm3) and then wrapped in muscle fascia taken from the right rear leg. Each graft was placed on the back of the animal after measuring its weight, and then the rabbits were separated into two groups, viz, control and the SL-treated groups {10 mg/kg, per os (p.o.)}. The treatments were administered for 3 months, the rabbits were sacrificed, and the histopathological features and weight of the grafts were examined.Results: The weight of the grafts in the two groups did not significantly (p &lt; 0.05) differ but the histopathological results suggested that there was a pronounced increase in the viability of the graft tissues in the SL-treated group compared to the control group. Treatment with SL decreased the resorption rate and enhanced basophilia relative to the control group. However, fibrosis, inflammation, and bone metaplasia- and calcification-like factors did not significantly differ (p &lt; 0.05).Conclusion: Treatment with SL significantly enhances the viability of the grafts, and thus may have a beneficial effect on fascia-wrapped diced cartilage grafts.Keywords: Scopoletin, Rhinoplasty surgery, Fascia-wrapped diced cartilage graft, Histopathology, Basophilia, Inflammation

A Modified Suction-Assisted Technique of Transfer of Diced Cartilage Graft to Carrier Material and Outcome of Direct Injection of Unwrapped Diced Cartilage in Rhinoplasty.

To describe a modified suction-assisted technique (MSAT) of transfer of diced cartilage (DC) graft to a carrier material and to determine the clinical outcome of direct injection of unwrapped diced cartilage (UDC) in rhinoplasty. Department of Plastic Surgery, KEMU, Mayo Hospital, Lahore from February 2011 to January 2015 METHODS:: Forty-seven patients of both genders with types 0 to 3 saddle nose deformity were included. Patients with types 4 and 5 saddle nose deformity, diabetes, hypertension, hepatic or renal disorders were excluded. Open tip rhinoplasty was performed in all patients. Eighth and/or ninth costal cartilage was harvested. Cartilage graft was diced into 1 to 2 mm pieces. The DC graft was transferred to carrier material (1-mL syringe) with MSAT. The UDC was then injected into nose and clinical outcome was determined. Out of 47 patients included in the study 62% were females with mean (standard deviation [SD]) age 22 (4) years. Thirty-four (72%) procedures were primary rhinoplasties while 13 (28%) were secondary rhinoplasties. Mean (SD) carrier material filling time was 12±3 seconds. All operating surgeons involved in study were satisfied with modified suction technique and declared it better than the traditional manual technique of filling the carrier material. Most of the patients were satisfied with their postoperative nasal appearance and complications were minimal. One patient required revision of surgery due to dorsal contour irregularities and another due to partial cartilage absorption at 13 ± 2 months follow-up. Our MSAT of transfer of DC and injection of UDC is simple, easy to perform, reduces operative time and produces acceptable cosmetic outcome as regard patient's satisfaction.

Cartilage Scales Embedded in Fibrin Gel.

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Dorsal Onlay with Diced Homologous Processed Rib Cartilage Grafts.

Diced cartilage wrapped in fascia or modeled with tissue sealant has successfully been used as dorsal onlay grafts in rhinoplasty. The use of autologous material introduces the risk of donor site morbidity, and sometimes availability is limited. We present a series of nine cases that were performed using diced irradiated homologous rib cartilage as an onlay graft. Good functional and cosmetic outcomes were achieved in all nine patients, and no significant resorption was seen after a mean follow-up of 20months. Homologous diced cartilage grafts are an attractive and well-tolerated alternative. The use ofdiced homologousmaterial does not seem to lead to significant resorption. These results must bereproduced in larger series. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of chest deformity caused by microtia reconstruction: Comparison of autogenous diced cartilage versus cadaver cartilage graft partial filling techniques

Efforts to prevent chest wall deformity after costal cartilage graft are ongoing. In this study, we introduce a new method to prevent donor site deformation using irradiated cadaver cartilage (ICC) and compare this method to the autogenous diced cartilage (ADC) technique. Forty-two pediatric patients comprised the ADC group (n=24) and the ICC group (n=18). After harvesting costal cartilage, the empty perichondrial space was filled with autologous diced cartilage in the ADC group and cadaver cartilage in the ICC group. Digital photographs and rib cartilage three-dimensional computed tomography (CT) data were analyzed to compare the preventive effect of donor site deformity. We compared the pre- and postoperative costal cartilage volumes using 3D-CT and graded the volumes (grade I: 0%-25%, grade II: 25%-50%, grade III: 50%-75%, and grade IV: 75%-100%). The average follow-up period was 20 and 24 months in the ADC and ICC groups, respectively. Grade IV maintenance of previous costal cartilage volume was evident postoperatively in 22% of patients in the ADC group and 82% of patients in the ICC group. Intercostal space narrowing and chest wall depression were less in the ICC group. There were no complications or severe resorption of cadaver cartilage. ICC support transected costal ring and prevented stability loss by acting as a spacer. The ICC technique is more effective in preventing intercostal space narrowing and chest wall depression than the ADC technique. Samsung Medical Center Institution Review Board, Unique protocol ID: 2009-10-006-008. This study is also registered on PRS (ClinicalTrials.gov Record 2009-10-006).