Diced Cartilage Grafts Research Articles

Viability of Crushed and Diced Cartilage Grafts: A Study in Rabbits

Viability of Crushed and Diced Cartilage Grafts: A Study in Rabbits

Radiologic and Histologic Assessment of Diced Cartilage Grafts for Cranial Bone Defects of Rabbits: An Experimental Study

This study was performed to experimentally evaluate the viability and coverage of diced cartilage grafts for cranial defects. Biparietal bone defects were prepared in each of 20 rabbits. Otogenous bone grafts were fixed to one side, whereas cartilage grafts taken from the right ear, diced, and wrapped with oxidized regenerated cellulose (Surgicel) were placed on other side. Parenchymal impression, contour, and ossification of all grafts in the 16 rabbits surviving after 8 weeks were evaluated with computed tomography and magnetic resonance imaging. The existence of ossification was examined pathologically. Parenchymal impression was significantly more frequent in bone grafts than in cartilage grafts (p < 0.05). This difference probably is attributable to the application technique. There was no significant radiographic difference in other parameters between the two groups. No significant difference in ossification was found. In conclusion, ossification was seen radiologically and pathologically in diced cartilage grafts. Because of autogenicity, ease of shaping, absence of postoperative warping, reduced resorption rates, and inherent viability and ossification properties, the authors suggest that diced cartilage grafts may be an alternative material for cranial defects, especially for frontal cranial reconstruction in which deformities may cause aesthetic and functional disabilities. The authors believe that further long-term studies also are needed.

Comparison of Diced Cartilage Graft Wrapped in Surgicell and Diced Cartilage Graft Wrapped in Fascia: An Experimental Study

This study was conducted to compare diced cartilage grafts wrapped in fascia and diced cartilage grafts wrapped in surgicell with respect to their resorption. Experimental study. Eight male Wistar Albino rats were used. After general anesthesia, two different subcutaneous pockets (upper and lower pocket) were prepared in the rat's abdomen. Surgicell-wrapped homograft that was taken from the ear was placed into the upper subcutaneous pocket. Fascia-wrapped homograft which was taken from the ear was placed into the lower subcutaneous pocket. All the rats were killed at the end of 2 months, and the samples were collected to be examined histopathologically. Cartilage mass, foreign body reaction, fibrosis, chronic inflammation, and vascularization were researched. Diced cartilage wrapped surgicell stained negative for glial fibrillary acidic protein (GFAP). Diced cartilage wrapped in fascia stained positive for GFAP. There was a significant difference between two groups with respect to fibrosis, chronic inflammation, and cartilage mass. There was no significant difference between the two groups regarding vascularization. This study suggests that diced cartilage graft wrapped in surgicell was absorbed, whereas diced cartilage graft wrapped in fascia was not.

Viability of Crushed and Diced Cartilage Grafts

To investigate the effects of dicing and different degrees of crushing on cartilage graft viability and outcome in rhinoplasty. Cartilage was harvested from both ears of 29 rabbits. For each animal, 6 cartilage pieces were prepared as follows and inserted into the paraspinal subcutaneous tissue: (1) left intact, (2) diced to approximately 1 x 1-mm pieces and then wrapped in oxidized regenerated cellulose, (3) slightly crushed, (4) moderately crushed, (5) significantly crushed, and (6) severely crushed. Animals were killed at 2, 5, and 10 months, and graft specimens were microscopically examined. As crushing intensity rose, cartilage viability decreased and more cartilage tissue was transformed to connective tissue. The intact and slightly crushed grafts showed significant chondrocyte proliferation. This decreased as crushing intensity increased, and the severely crushed and diced cellulose-wrapped grafts exhibited almost no peripheral chondrocyte proliferation. Slight crushing of a cartilage graft can produce outstanding graft material that forms softer nasal contours and fills defects well. However, severe crushing of cartilage grafts results in extensive necrosis and eventual reduction in graft volume. The use of oxidized regenerated cellulose to wrap diced cartilage grafts also tends to reduce clinical predictability owing to negative effects on cartilage viability and regeneration.

Diced cartilage grafts in rhinoplasty surgery.

The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the publication of his technique for "Turkish delight" grafts (i.e., diced cartilage grafts wrapped in Surgicel). The present study details the authors' experience with 50 consecutive diced cartilage grafts used in three configurations during a prospective study of 50 primary and secondary aesthetic rhinoplasty procedures performed by the senior author (Daniel). Part I consists of 22 diced cartilage grafts wrapped in Surgicel and placed in the radix (n = 14), radix/upper dorsum (n = 4), and full-length dorsum (n = 4). All grafts were performed adhering meticulously to Erol's technique without modification. This portion of the study was halted abruptly at 4 months because of the unexpected absorption and clinical failure of all diced cartilage grafts wrapped in Surgicel. Subsequently, five patients had revision surgery, and biopsy specimens were taken at the prior grafting site and analyzed histologically. After this clinical failure, part II of the study began, consisting of 20 patients who had diced cartilage grafts wrapped in fascia. The range of applications was comparable: radix (n = 12), radix/dorsum (n = 3), and full-length dorsum (n = 5). Because of our prior practice of overcorrecting by 20 percent with diced cartilage grafts wrapped in Surgicel, we had excessive amounts of material in six of our initial diced cartilage wrapped in fascia radix grafts, but no subsequent grafts. The overcorrections were easily reduced at 6 weeks to 11 months postoperatively using a pituitary rongeur under local anesthesia, and the material was sent for histologic analysis. Minimum 1-year follow-up of all 20 cases has shown maintenance of the grafts without evidence of absorption. Part III of this study comprised eight patients who had diced cartilage grafts without a fascial covering placed throughout the nose, including on the sides of osseocartilaginous rib grafts to the dorsum. At 14 months, there was no evidence that any of these grafts had been absorbed. Histologic analysis of the biopsy specimens from the diced cartilage grafts wrapped in Surgicel showed evidence of fibrosis and lymphocytic infiltrates with small amounts of Surgicel visible on birefringent microscopy. Remnants of cartilage were present but were metabolically inactive on the basis of negative glial fibrillary acidic protein staining. Control specimens of fresh septal cartilage and banked septal cartilage were remarkably similar to each other and demonstrated normal cartilage architecture and cellular activity. The diced cartilage grafts wrapped in fascia showed coalescence of the diced cartilage into a single cartilage mass, with viable cartilage cells and normal metabolic activity on the basis of glial fibrillary acidic protein staining. All of the diced cartilage grafts wrapped in Surgicel absorbed and failed to correct the clinical problem for which they were performed. All of the diced cartilage grafts wrapped in fascia and pure diced cartilage grafts did correct the clinical deformities and appear to have survived completely. The diced cartilage grafts wrapped in fascia placed along the dorsum were distinctly palpable throughout the postoperative period, as was one prior case with a 6-year follow-up. The authors' clinical experience confirms the experimental studies of Yilmaz et al. that question the use of Surgicel for wrapping diced cartilage grafts in clinical rhinoplasty surgery.

Nasal augmentation with Surgicel-wrapped diced cartilage: a review of 67 consecutive cases.

Cartilage grafting has been used extensively to correct both the functional and aesthetic aspects of the nasal framework. The technique described by Erol ( 105: 2229, 2000) uses Surgicel-wrapped diced cartilage grafts in rhinoplasties. The advantages include its ease of preparation, the large volume of graft substrate available for use, and the avoidance of contour irregularities in the areas of placement. A retrospective case review of 67 consecutive patients who were treated with a Surgicel-wrapped diced cartilage graft as part of an aesthetic and/or functional rhinoplasty, in a 5-year period between 1995 and 2000, was performed in this study. All cases of congenital nasal deformities or deformities caused by trauma or tumors in which the technique was used were excluded. The charts were reviewed to determine demographic variables, the surgical procedures performed, prior operations, the rhinoplasty approach used, and the graft donor and recipient sites. Preoperative and postoperative photographs were examined, and the results were assessed. Data on the donor and recipient sites, complications, and the necessity for revisionary procedures were tabulated. There were two complications, namely, an infection, which resolved with aspiration and oral antibiotic therapy, and a recurrence of a dorsal depression, which necessitated repeated augmentation within 6 months. The technique of using Surgicel-wrapped diced cartilage proved to be effective for the augmentation of various areas of the nose. The complication and revision rates were acceptable and comparable to those of other techniques. Patient satisfaction with the aesthetic results was rated highly, with no reports of graft extrusion or contour irregularities. This technique is recommended for nasal augmentation and contouring for selected rhinoplasty patients.

Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts.

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.

Chin augmentation using diced cartilage

Eight patients with microgenia have undergone augmentation with diced nasal cartilage. Cartilage grafts were harvested from the nose during rhinoplasty. These grafts were cut into 0.5 to 1.0 mm pieces using a #11 blade and were wrapped in one layer of Surgicel (oxidized regenerated cellulose). This cartilage mass was inserted into the chin pocket. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and photography. These investigations showed that diced cartilage grafts maintained 75% of their dimensions at six months after implantation. The follow-up period was 12 months, and the aesthetic results were satisfactory.

The use of diced cartilage as a testicular replacement in rabbits

Silicone prostheses have primarily been used for cosmesis after orchiectomy, but complications have been reported. In this experimental study, diced cartilage graft has been used for testicular replacement in rabbits. Although later reduction of the volume was seen in the MRI studies, diced cartilage grafts can be used for testicular prostheses but overcorrection of the volume seems to be desirable.

Diced cartilage grafts to correct enophthalmos.

A technique is described using diced cartilage grafts to correct the volume deficit which is responsible for many of the unsatisfactory cosmetic features following enucleation.

Computer Aided Volume Measurement Using Osirix, A Free 3D-Rendering Software, In Preplanned Correction Of Enophthalmos With Diced Cartilage Graft

Autologous costal diced cartilage graft is an option for replenishment of the volume deficit in residual enophthalmos following orbito-zygomatic trauma. However, in published journals referring this treatment option, quantitative volume measurement of the graft needed has not been established. Two patients with orbito-zygomatic fractures resulted from motorcycle accidents, presented with dystopia, entrapment of the eyeball, diplopia, and depressed malar eminence on the affected side. CT scans demonstrated orbital-floor disruption and herniation of the intra-orbital content into the maxillary sinus. Using OsiriX®, a free and open source medical imaging software, we calculated the volume discrepancy of the affected orbit. On coronal slices, the segmentation of the bony orbital region of interest of each single slice was performed and grouped to compute the volume. At surgery, diced cartilage grafts were inserted to the orbital cavity according to the calculated volume, to promote forwards shift of the eye globe position after releasing the entrapment and replacing the orbital floor. In both patients, good position of the eye globe was achieved. The aesthetic appearance was perceived as quite acceptable to the patients and other viewers. Transient diplopia settled within 3 months. We considered OsiriX® as a reliable tool for accurate quantitative measurement of diced cartilage graft volume in enophthalmos correction.

The Experience of Using Various Modalities For Orbital Floor Fracture Reconstruction

Background: Fractures of the orbital floor require surgical intervention in group of patients with cosmetic problems and/or vertical diplopia. The surgical management of these patients provides a great challenge to the surgeon. A variety of implant materials have been used to recreate normal bony orbital dimension or supplement deficient orbital volume which include alloplastic or autogenous materials. The purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh, absorbable mesh and “Turkish Delight” diced cartilage graft.Patients and Methods: From 2006-2010, we treated eight patients with orbital blowout fracture using various modalities. We used titanium mesh, absorbable mesh, calvarial bone graft and “Turkish delight” diced cartilage. These various modalities were chosen based on clinical examination, patient satisfaction, radiographic investigations and the cost on managing patient.Result: Calvarial bone graft were performed in two patient, “Turkish delight” diced cartilage in one patient, absorbable mesh in one patient, and titanium mesh in four patient. All patients had satisfactory result with adequate volume correction and reduction in vertical diplopia.Summary: All four materials, calvarial graft, titanium mesh, absorbable mesh, and “Turkish delight” diced cartilage graft have the potential to be useful reconstructive materials in orbital floor blowout fractures based on holistic consideration.

Absorption of autogenous cartilage grafts in man

Summary 1.In the course of previous work it was noted that surface absorption had occurred in a human cartilage autograft two months after transplantation. This observation has been investigated by studying twenty-five autografts which had remained in the tissues for periods ranging from two months to thirty-seven years. 2.Absorption had affected every surface which had been bared of perichondrium prior to grafting. By contrast, an intact perichondrial layer protected the underlying cartilage. 3.The absorptive process appeared to be of short duration and to be completed within a few weeks after transplantation. 4.The degree of absorption varied widely; when severe it could result in a significant decrease in the bulk of the graft. In diced cartilage grafts the shrinkage may be of clinical importance because of the increased surface exposed; the smaller the dices the greater will be the loss in volume. 5.The possible ˦tiological factors and the surgical implications are discussed.

Reconstruction of the Auricle with Diced Cartilage Grafts in a Vitallium Ear Mold

Reconstruction of the Auricle with Diced Cartilage Grafts in a Vitallium Ear Mold