Rib Cartilage Graft Research Articles

喉頭外傷 (外損傷) の治療

Three cases of external laryngeal trauma due to traffic accident were reported.Case 1, an 18-year-old male, was hospitalized due to increasing dyspnea and dysphonia. Tracheotomy following naso-tracheal intubation was performed, and the patient was symptom free two weeks later without further surgical treatment.Case 2, a 31-year-old male, was admitted with laryngeal framework fracture and other multiple injuries. Tracheotomy and stent insertion to the larynx were done to establish his airway and to support the laryngeal framework. Three months later, he was discharged with mild dysphonia.Case 3, an 18-year-old male, was transferred from another hospital with difficult decanulation following tracheotomy for laryngeal trauma. We performed staged operations; upper tracheal re-construction using rib-cartilage graft and thyroplasty type 1. Normal airway and improved voice were obtained after these operations, and the patient returned to a normal social life.In this paper, we emphasized that the goals of treatment for laryngeal trauma are to establish an adequate airway and to obtain a satisfactory voice. Furthermore, the necessity of strict course observation and the usefulness of some surgical technics for laryngeal trauma were discussed.

Control of grafted rib cartilage warping

The main problem associated with grafting rib cartilage to the nasal dorsum is postoperative warping. This study evaluated the use of a metal rod to prevent the rib cartilage from warping. The 8th rib cartilages, taken bilaterally from eight young fresh human cadavers, were carved into blocks 6×6×35 mm. Blocks obtained from the right side of the cadavers were pierced with a Kirschner's wire (O0.7 mm) along their long axis. After scoring one side of all the blocks at 1 mm intervals to a depth of 2 mm, they were immersed in saline solution. 48 h after scoring, the curvature of the blocks with a rod was significantly less than the curvature of the blocks without a rod (mean=4°, 42° respectively, p<0.001). The results suggest that a metal rod, used as a strut for rib cartilage graft, prevents postoperative warping and may obviate the need for a second operation.

Tracheoplasty for congenital complete tracheal rings: Andrews T.M.; Cotton R.T.; Bailey W.W.; Myer C.M. III; Vester S.R.Arch. Otolaryngol. Head Neck Surg. (USA) (1994) 120/12 (1363–1369)

This chapter presents an overview of regenerative medicine of the respiratory tract. Olfactory ensheathing cells are a class of glial cells, which support regeneration of olfactory receptor neurons in the olfactory epithelium. When transplanted to other regions of the brain they may support regeneration of other classes of neurons. They also support axon regeneration and are successfully employed in rat models of spinal cord regeneration. Human nasal septum is a good source of chondrogenic cells with the potential to be used to engineer transplants for restorative surgery in otolaryngology. Partial laryngeal reconstruction is required for stenosis in children and adults and after resection of carcinomas in adults. Conventional means of restoring subglottic lumen include endoscopic techniques, which need repeating, large segmental resections, or the insertion of rib cartilage grafts. The synthetic or biological scaffolds may form the basis for myoblast progenitor cell proliferation and differentiation. The use of dynamic bioreactor “preconditioning” causes fiber-type differentiation into the appropriate MyHC subtypes (slow versus various forms of fast fibers) and, crucially, orientation of myotubes. The only curative treatment of any tracheal lesions involving less than 50% of the total length of the trachea is achieved by segmental resection followed by tracheal mobilization and primary end-to-end anastomosis in adults and/or slide tracheoplasty in children with long-segment tracheal stenosis.

External Ear Reconstruction With Autogenous Rib Cartilage

For more than 30 years, children born without an ear or with deformities have had their defects corrected by ear reconstruction with autogenous rib cartilage graft. Despite the common use of this procedure, total ear reconstruction continues to be one of the greatest challenges facing the reconstructive surgical team. In this article, plastic surgical nurses are provided crucial information regarding anatomy and physiology, assessment, the surgical procedure, and perioperative patient care.

Microtia repair with autogenous rib cartilage grafts

Over the past 2 decades, the author has developed techniques to implement autogenous tissues in the repair of microtia in patients of all ages. Cartilage grafts, unlike bone grafts, do not require functional stress to ensure their long-term survival. Therefore, the constructed ear in the young patient probably can be expected to grow at least as much as the normal ear. Surgical construction of the auricle with autogenous tissues is a unique marrying of science and art. Although the surgeon's facility with both sculpture and design is imperative, the surgical result will be equally influenced by his/her adherences to sound principles of plastic surgery and tissue transfer.

Auricular Repair with Autogenous Rib Cartilage Grafts

Auricular Repair with Autogenous Rib Cartilage Grafts

Auricular Repair with Autogenous Rib Cartilage Grafts

The purpose of this paper is twofold: to present a sound approach to auricular construction using methods that have evolved through two decades of my personal experience with 600 cases and to discuss pertinent information I have gleaned from a questionnaire sent to my operated patients. This series comprises 546 completed ears in 500 microtia patients (46 bilateral) and 75 completed ears in acquired deformities. Follow-up ranges from 1 to 17 years. Major complications such as infection, hematoma, or skin loss with cartilage exposure occurred in only 1.6 percent of cases and were limited to the perioperative period of 12 days. None have occurred in the last 9 years (481 frameworks). This paper describes the evolution and rationale for my current management of total ear repair and covers preoperative planning, how to fabricate the rib cartilage framework, how to modify the framework for specific deformities, and how to cover the framework, i.e., how to assess and use local skin and vestiges or when to supplement the coverage by recruiting fascial flaps or using tissue expansion. When considering fascial flaps, patient selection was found to be particularly important because of long-term effects on the donor scalp; expansion was found to be most useful intraoperatively. This paper also covers how to manage the hairline, how to stage the surgery, when to combine procedures, and how to manage bilateral microtia in a team approach. The survey revealed that autogenous cartilage frameworks grow, are durable, retain their detail over the years, and withstand trauma well. More than 40 severe traumas occurred in surgically constructed ears, and all healed without incident. Ears constructed in young patients generally grew to keep pace with the opposite normal side; 41.6 percent actually overgrew by several millimeters. Emotional and psychological benefits were universal, and patient satisfaction was high. Among patients who were classified as "severely affected" by the original deformity, 100 percent were pleased with the result. When considered "moderately disturbed" by the microtic defect and operated on by age 14, 95.5 percent of patients were satisfied with the surgical repair; 83.3 percent of adolescents between the ages of 15 and 20 who did not consider themselves "severely affected" by the deformity were pleased with the outcome, and the rest were "undecided."

Fresh autogenous rib cartilage graft to the malar process of rats with and without removal of the perichondrium: a histological study.

A comparison was made of autogenous grafts of rib cartilage with and without removal of the perichondrium, applied to the malar process of rats. Seventy-two male albino rats were divided into two groups according to the kind of graft received by each animal. The experimental periods were 5, 10, 20, 30, 60 and 120 postoperative days. The results showed that, in the control group, the grafts maintained their vitality for the whole experimental period and the perichondrium was biologically integrated into the host bed. Appositional growth was also observed. The treated animals showed intense resorption of the grafts and more intense bone neoformation. The newly formed bone was in intimate contact with the graft in both groups.

Acquired tracheal stenosis in infants and children

Acquired tracheal stenosis in childhood is frequently difficult to manage because of poor healing, infection, and scarring. In a 10-year period, 62 patients (4 weeks to 14 years of age) were treated for acquired tracheal stenosis. The causes of stenosis were endotracheal intubation (44 patients), caustic aspiration (6 patients), recurrent infection (5 patients), bronchoscopic perforation (4 patients), and gastric aspiration (3 patients). The subglottic or upper trachea was involved in 47 patients, mid portion in 8, and distal or carinal area in 7. Fifty children underwent tracheostomy as part of the therapy, and 12 were managed without tracheostomy. Therapy was individualized, frequently sequentially, utilizing rigid or balloon dilatation (20 patients), bronchoscopic electrocoagulation resection (44 patients), steroid injection (48 patients), T tube stent (8 patients), resection with anastomosis (12 patients), cricoid split (3 patients), and rib cartilage graft (12 patients). Most patients required several techniques and repeated procedures to eventually achieve decannulation. Seven patients (11%) died of unrelated causes. Forty-four of 55 surviving patients (80%) are without tracheostomy, although 14 have required continued endotracheal treatment after tracheostomy removal (dilatation, endotracheal resection). This series demonstrates that acquired tracheal stenosis in childhood is a common, difficult problem, but manageable with the use of a variety of techniques. Resection and grafting procedures should be reserved for cases in which less complex modalities fail.

Surgical Management of Tracheal Stenosis in an Infant with Multiple Congenital Anomalies: When is Baby Inoperable?

Congenital tracheal stenosis is a rare disorder that carries a significant morbidity and mortality. It is an even greater challenge when present in combination with other life-threatening congenital anomalies. We present an infant with multiple congenital anomalies, including trisomy 21, who was diagnosed with congenital tracheal stenosis at 3 months of age. At age 5 months, the infant underwent tracheoplasty with costal cartilage graft and pulmonary artery banding. Bronchoscopy 3 weeks later revealed a patent airway. However, the patient died 2 months postoperatively of cardiac complications. At autopsy, whole organ and histologic specimens revealed excellent incorporation of the graft with no evidence of re-stenosis. Our documentation of graft incorporation in this patient is evidence that long segments of stenotic trachea can be successfully treated by tracheoplasty utilizing rib cartilage grafts.

Tracheobronchial Obstructions in Infants and Children

Forty-five infants and children with intrathoracic tracheobronchial obstructions requiring surgical treatment are reported. Segmental stenosis of the trachea is defined as involvement of less than one half the length of the airway, which affected six infants. Elongated stenosis involving more than one half the length of the trachea was seen in 12 infants, and complete annular cartilage rings, along the entire length of the trachea, were present in 11. Severe tracheomalacia occurred in six infants associated with aortic arch anomalies and in nine infants with esophageal atresia. Segmental tracheal resection was performed in 17 cases (two after failure of a rib cartilage graft), and anastomotic stricture developed in three. These three anastomotic strictures were resected, resulting in an excellent airway in two and restricture in one. Rib cartilage grafts were used in five patients: two of three with elongated stenosis with complete tracheal rings required subsequent resection, and one of two infants with tracheomalacia had excellent outcome. Approximately 50% of an infant's trachea can be resected, but rib cartilage grafts should be used for elongated stenosis. Resection of bronchial stenosis in two patients resulted in a widely patent bronchus. From this experience primary segmental tracheobronchial resection and re-resection of recurrent stenosis are highly successful. Anastomotic stricture is due to tension at the suture line and suture material inciting a fibrotic reaction. Rib cartilage grafts amounting to 25% or less of the circumference of the airway readily resurfaces with adjacent epithelium, but when 30% or more of the circumference is rib graft, epithelialization may be impaired.

Reconstruction of penis with free deltoid flap

Two cases of reconstruction of the penis with a free deltoid flap are described. The urethra was reconstructed with part of the flap and external coverage of the penis was provided with the remainder. In one case an autogenous rib cartilage graft was inserted in the reconstructed penis as a strut. Postoperatively both patients can urinate standing up, and for the one in which a rib cartilage graft was used sexual intercourse is possible. Both cases have good recovery of tactile and protective sensation in their reconstructed penis.

Evaluation of Porous Polyethylene for External Ear Reconstruction

Autogenous rib cartilage and silicone rubber are materials currently used for ear reconstruction. Increased morbidity and operative time with rib cartilage grafts and a high rate of extrusion with silicone implants render them less than ideal for reconstruction of the human ear. The purpose of the current investigation is to determine the efficacy of porous polyethylene as an alternative synthetic material for ear reconstruction. Porous polyethylene and silicone rubber discs of equal sizes in two thicknesses were implanted in lieu of the cartilage in the external ear of eight baboons. Histological evaluation of the sites after nine weeks revealed excellent anchorage of the thin porous polyethylene implants (1.5 mm) in the surrounding tissues. Silicone rubber implants, however, were encapsulated in a thickened granulation tissue capsule. When thicker implants (3.0 mm) were used, exposure or extrusion occurred in all cases. Porous polyethylene implants demonstrated only partial exposure; half of the silicone rubber implants were extruded; and the other two silicone rubber implants were almost completely extruded. Porous polyethylene was thus better incorporated into the soft tissues than silicone rubber as long as the overlying soft tissues were not stressed by an oversized implant or inadequate soft tissue coverage.

Rib cartilage grafts for the treatment of posterior glottic and subglottic stenosis in children.

Posterior glottic and subglottic stenosis from endotracheal intubation in children can be managed endoscopically with varying success. Open surgical treatment offers a better potential for correction with a single procedure in moderate and severe cases. The open method consists of splitting the scar and cricoid cartilage posteriorly to the level of the interarytenoid muscle, then stenting the incised cricoid open with a rib cartilage graft. Use of this method is described, and results in 12 cases are reported. Decannulation was achieved in ten patients. In all patients who were decannulated, good exercise tolerance, freedom from aspiration, and an adequate voice quality were achieved.

A Simple Method for the Correction of Enophthalmos

Autogenous rib cartilage grafts are used to correct enophthalmos. The grafts are introduced through two small tunnels into the posterior quadrant of the orbit. The procedure leaves almost no scar and final results are satisfactory.

Aufbau der Nase mit autologem Rippenknorpel

Thirty-six patients with severe difficulty in breathing in the case of saddle nose deformity, hidden columella, loss of cartilage in the lower part of the septum and septum deviation are treated by implantation of autogenous rib cartilage grafts in combination with septo-rhino-plastic. In all cases always two pieces of cartilage are formed, one for the part of the columella septum and the other for the saddle of the nose. Only the central parts of the rib cartilage were used without the perichondrium and without the outer layers of the cartilage. The operative procedure and the results are described. The follow up is 0.5 up to 4 years.

A spectrum of application of autogenous costochondral grafts

Autogenous costochondral grafts have found application in 26 variegated cases of congenital dysplasia, ankylosis, neoplastic disease, osteoarthritis, and post-traumatic dysfunction. The authors' experience with the grafting procedure has been generally favourable, but various difficulties have also arisen. There is a cursory discussion on the physiological superiority of rib cartilage grafts over those of other autogenous joints in reconstruction of the temporomandibular articulation.

Absorption of human rib cartilage grafts transplanted to rabbits after preservation by different methods

Absorption of human rib cartilage grafts transplanted to rabbits after preservation by different methods

Absorption of human rib cartilage grafts transplanted to rabbits after preservation by different methods

Summary In fresh human cartilage grafts stored in Ringer's solution or in air, single cells, exceptionally a large number of cells, take supravital dyes after transplantation to rabbits. The period following transfer does not exert any visible influence on the supravital staining of cells: either they die after a short time or they adapt and then take supravital staining for a longer period. At first the inflammatory infiltration of the host tissue is rather intense. At this time a neutral cell-free necrotic zone forms between graft and host tissue, which gradually decreases and is replaced by a fibrous capsule which may contain areas without any sign of inflammation. Grafts preserved in merthiolate, formalin, and alcohol undergo a more rapid decrease of inflammatory infiltration than do fresh and deep-frozen grafts. Signs of absorption occur more frequently in devitalised grafts than in fresh grafts stored in Ringer's solution or in air. The host's reaction against the graft may be in indirect proportion to the degree of absorption. At the beginning a neutral necrotic zone prevents the graft from being absorbed by the surrounding connective tissue. In the course of time the host-against-graft reaction diminishes. The neutral zone disappears. Host tissue and graft come into immediate contact with each other. Either a fibrous capsule forms or the surrounding tissue invades the graft and the absorption begins. Because of the findings in rabbits it is suggested that fresh grafts stored in Ringer's solution or in air at +3° C. are preferable for clinical use.