Rib Graft Research Articles

Open laryngotracheal reconstruction for iatrogenic posterior glottic stenosis in adults: international multicenter experience.

Posterior glottic stenosis (PGS) has a significant impact on breathing and quality of life, and remains a challenging condition to manage. Literature does not provide a single optimal approach. In this study we aim to assess post-operative outcomes of adult patients with acquired PGS treated with open laryngotracheal reconstruction (LTR) with autologous or cadaveric rib grafting. This multicenter retrospective cohort study included adults who underwent open LTR for iatrogenic PGS (2015-2023) and were followed for 26 months on average. Data on comorbidities, surgical complications, and interventions following surgery were collected. Forty-three adult patients were included. Decannulation was successful in 76.7%, and 53.5% of patients required an endoscopic or open revision procedure for recurrent stenosis during the mean post-operative follow-up of 26 months. Patients with severe obesity (BMI ≥ 35), moderate to severe co-morbidity (ASA ≥ 3) or Chronic Kidney Disease were significantly more likely to fail decannulation after LTR. Diabetes Mellitus and ASA ≥ 3 were significant negative predictors for intervention-free survival. There were no significant differences in decannulation rate or intervention free survival between patients that had LTR with autologous (n = 26) versus cadaveric (n = 17) cartilaginous grafting. This study describes the largest consecutive multicenter cohort of adult PGS patients treated with open LTR. This technique significantly improves breathing outcomes in PGS, with minimal complications in selected patients with a healthy weight and few comorbidities. Patients with a BMI ≥ 35, ASA ≥ 3, Diabetes Mellitus or renal failure have less favorable outcomes, with respect to decannulation rates and intervention-free survival.

The Use of Autogenous Rib Graft in Craniofacial Reconstruction: Case Series Study

Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. The method of choice in the treatment of facial defects is autogenous bone grafts. Objectives: To evaluate the use of rib grafts in the reconstruction of craniofacial deformities. Methods: This prospective study was presented for the reconstruction of craniofacial deformity using a rib bone graft. These cases were collected from the Maxillofacial Surgery Unit from October 2011 to November 2020. The sample consisted of 16 patients (14 males and 2 females, with a mean age of 34 years). The patients were divided according to the site of the defect. In all cases, a single rib was harvested. The fifth rib was taken. Bone graft fixation by bone plate, direct screws, and transosseous wiring. The success of the bone grafting was assessed by clinical and radiological examination. Results: The overall success rate in this study was 87.5%, while we had bone graft resorption in two cases (12.5%) of mandibular reconstruction. Only one case experienced donor site complications, a pleural tear, which successfully underwent suturing and chest tube insertion. Conclusions: Free autogenous rib was successfully used to reconstruct defects in the maxillofacial regions. It gives the best result when minimum loading is needed. Stabilization of the graft by rigid internal fixation and good adaptation to the recipient site helped to minimize complications.

Predictors of 30-day complications, readmission, and postoperative length of stay in children undergoing autologous rib grafting for microtia

BackgroundPredictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors. ObjectivesTo explore predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting. MethodsThe Pediatric National Surgical Quality Improvement Program was queried for patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012–2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare preoperative characteristics with postoperative outcomes. Results667 patients met inclusion criteria. 63 (9.4%) had at least one complication and 19 (2.9%) were readmitted. Univariate analysis showed inpatient status (p=0.011) and race (p=0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p=0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p=0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p<0.001) and inpatient status (35.3% increase, p<0.001). Postoperative length of stay was shorter for outpatients (45.45% shorter, p<0.001) and cases performed by plastic surgeons (14.2% shorter, p<0.001). ConclusionMicrotia reconstruction with autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling.

The Lateral Wall of the Inferior Meatus as a New Graft Source for Rhinoplasty: Radiological Study and Surgical Technique.

Generally, revision rhinoplasty cases require the use of stiff grafts to restore the lost support. However, the majority of patients indicated for revision surgery present with a lack of a bony cartilaginous framework of the septum, especially after previous septoplasty. Thus, surgeons are compelled to harvest costal cartilage. At the same time, rib graft harvesting is associated with additional trauma and a risk of serious complications. Being ENT surgeons, we often resect a part of the lateral wall of the inferior nasal meatus during the extended endoscopic approach to the maxillary sinus. We supposed that this bone plate could be used as a donor site for rhinoplasty graft harvesting. The aim of our study was a radiological assessment of the feasibility and limits of using the inferior meatus lateral wall (IMLW) as a donor site for rhinoplasty bone graft.A retrospective evaluation of 100 CT scans of sinuses was conducted. Further measurements of the IMLW were performed: average length and width (28.06 ± 4.03 mm and 19.73 ± 3.08 mm, respectively), thickness (0.62 ± 0.21 mm), and average deviation from the sagittal plane (17.7 ± 9.53 degrees). According to the obtained measurements, the described donor site is appropriate for harvesting nice straight bony fragments.The IMLW bone graft was used in four revision rhinoplasty cases. There were no postoperative complications. During the long-term follow-up, patients reported significant improvement in aesthetics, function, and social aspects according to Rhinoplasty Outcome Evaluation. Thus, the described technique is an easy and safe method for bone harvesting for revision rhinoplasty. Our first experience demonstrated the convenience and stability of IMLW grafts for revision rhinoplasty during the follow-up period of up to 2 years.

A Novel Endoscopic Anterior Cricoid Rib Grafting: A Feasibility Study in An Animal Model.

The objective of our study was to document the feasibility of a novel endoscopic anterior cricoid split and rib grafting technique in a goat airway model. Feasibility pilot animal study. Animal surgical laboratory at a tertiary hospital and research center. Three Ardhi goats were utilized. After harvesting and shaping the rib graft, 2 sutures were inserted transversely into the graft. An endoscopic midline anterior cricoid split was performed and extended down through the first tracheal ring, followed by a balloon dilation of the site. Next, the 2 lower and upper graft suture ends were sequentially passed as endo-extra laryngeal sutures and tied on the anterior neck skin. Laryngeal stent was utilized in 1 goat following graft placement. The surgery was successful in all included animals and bronchoscopy performed 7 days after surgery, revealed that the anterior graft was in good position. One goat developed surgical site infection leading to partial graft resorption. This study demonstrated the feasibility of this novel procedure which is potentially useful for patients who are candidates for a single-stage reconstruction. Future studies should investigate the safety and validity of this technique in a model with subglottic stenosis. NA.

Autologous rib grafts for craniocervical junction surgery in children: a clinical application

ObjectiveAutologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children.MethodsThe outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates.ResultsAll surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3–6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications.ConclusionAutologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.

Long-Term Results Using “Nair Hospital Precision Carving” Technique of Rhinoplasty

Abstract Background and Objectives Convincing a patient who has undergone any aesthetic surgery to come for a long-term follow-up is extremely difficult. The result obtained after rhinoplasty usually stabilizes in the first year and it is unlikely to change after 2 years. The precision carving technique described in 2014 has been employed by us for the last several years. We wish to present long-term results (at least 2 years) obtained using this technique, now renamed as “Nair Hospital Precision Carving technique.” The unfavorable effects of warping are most apparent in the dorsum. So, we have chosen to assess results of dorsal onlay grafts only. This article presents the long-term results obtained using favorable warping technique. Materials and Methods We have followed up 45 patients in whom dorsal augmentation was done using rib grafts for various indications like aesthetic, reconstructive rhinoplasty and cleft lip nasal deformity. Grafts were carved using the precision carving technique. Results All patients were assessed at 6 weeks, 6 months, and at subsequent follow-up period of 2 to 10 years and photographs were taken at each visit. There was no major complication and all patients were satisfied with the appearance. Conclusion The Nair Hospital Precision Carving technique utilizes unbalanced yet controlled and precise carving to achieve a variety of natural shapes for the objectives of contour fill and framework reconstruction in rhinoplasty, thus ensuring good long-term results.

Outcomes of dorsal nasal augmentation using costochondral graft.

To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.

Outcomes of dorsal nasal augmentation using costochondral graft

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. Method: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Results: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39+9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was ‘looking thick/swollen’ by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate. Key Words: Costal cartilage, Patient satisfaction, Rhinoplasty.

Development of an Algorithm to Determine Which Costal Cartilage to Harvest.

Rib graft is a common source of cartilage in rhinoplasty. Donor site choices for this resource were identified according to the authors who presented the introduction of this technique. However, the scientific basis of this valuable method lacks information, including the anatomical properties of costal cartilage. In this study, cartilage radioanatomy is examined and tested for if any estimators are present. A total of 148 thoracal CT scans of patients who applied to our facility were analyzed. Patients were divided per their sex and age of 35, and rib cartilage dimensions, including axial length between the sternal and costal ends of the cartilage (TotL), posteroanterior diameters at the sternal end (StDia), costal end (CosDia), the thickest part (MaxDia) as diametrical parameters and vertical height at the thickest part (h) were recorded. Length of the sternum (St), the axial length of the clavicle (ClavL), the distance of the sixth rib from the anterior axillary border (AntAx), and thorax circumferences at the level of both pectoralis major muscle origin (ThC) and nipples (BrC) were recorded. Statistical analyses were done for correlations. St, ClavL, ThC, and BrC were found to have the most correlated measurements in groups with the age of 35 and less of both genders, and the relations were lost in older groups. Thorax shape may change after the age of 35 years, but in younger patients, St in females and ClavL in males can be used as estimators of cartilage amount.

Autologous rib graft for posterior cervical fusion in pediatric patients: efficacy and safety in the early postoperative period.

The objective was to describe the indications, technique, and initial outcomes of autologous rib graft with recombinant human bone morphogenetic protein (rhBMP) in pediatric patients undergoing posterior cervical fusion. A retrospective study was performed of all pediatric patients who underwent autologous rib grafting with extra-small rhBMP-2 for posterior craniocervical or cervical arthrodesis at a single institution between May 2020 and July 2023. Patients with less than 3 months of postoperative follow-up and no postoperative CT data were excluded. Primary outcomes included presence of fusion on CT, 30-day perioperative complications, and rib harvest complications. Twenty-eight sequential patients met inclusion criteria. Thirteen were male, 15 were female, and the average age was 9 years. There were no surgical site infections or instances of postoperative seroma or unplanned return to the operating room. All patients had solid fusion on postoperative CT at 3 months. The average follow-up was 14.5 months, with a range of 4 months to 3 years. There were no complications associated with the rib harvest, including no instances of harvest site pain, and all patient incisions healed well. The authors' preliminary results demonstrate that autologous rib graft with extra-small rhBMP-2 is an effective strategy to achieve a high rate of fusion in pediatric patients undergoing posterior instrumented craniocervical or cervical fusion. In this series, the authors found an acceptable safety profile, without seroma, surgical site infection, unplanned return to the operating room, or rib harvest complications.

Contemporary Treatment of Microtia-Atresia.

Microtia-atresia is a congenital deformity affecting the external ear and ear canal that can present with varying degrees of severity and morbidity. Treatment occurs along a spectrum and primarily centers on improving aesthetic appearance. Many cases of microtia will not be effectively treated with conservative measures and will require some form of reconstruction. There are several options available, including porous polyethylene implants, autologous rib grafting, and autologous chondrocyte frameworks. Equally significant is the treatment of hearing loss, as many patients with microtia-atresia will have a component of conductive hearing loss. This article aims to comprehensively review contemporary treatment modalities for microtia-atresia and discuss the advantages, disadvantages, and practicality of each. Treatment and reconstruction often take a multidisciplinary and multistaged approach to achieve optimal results, with ideal management determined by each patient's individualized needs.

928 Autologous Rib Graft for Posterior Cervical Fusion in Pediatrics: Efficacy and Complications

INTRODUCTION: Cervical instability in the pediatric population presents unique challenges. Indication for fusion include instability or deformity from multiple causes. A recent meta-analysis showed high failure rate of successful arthrodesis after pediatric craniocervial fusion (over 30%). We describe use of autologous rib graft with BMP to augment fusion, evaluating efficacy and complication from this technique. METHODS: A retrospective study was performed between 2020 and 2023 of all pediatric patients (age 0-18) who underwent autologous rib grafting with extra-small BMP-2 for posterior craniocervical arthrodesis at a single institution. Patients with less than 3 month post-operative follow-up and no post operative CT were excluded. Primary outcomes include presence of fusion on CT, perioperative complication, and complication from rib harvest. RESULTS: Twenty-one patients met inclusion criteria. Ten were male, with average age 10 years (range 2 to 18). 87 total levels were fixated and fused, with no fixation screws misplaced on post operative CT. There were no surgical site infections, post operative seroma, or unplanned return to OR. All patients had solid fusion on postoperative CT. Average follow up was 268 days, with range of 45 days to 3 years. No patient had pain at the rib harvest on any post operative visit, and all rib incisions healed without complication. CONCLUSIONS: Our preliminary results suggest that autologous rib graft with extra-small BMP-2 is an effective strategy to achieve a high rate of fusion in pediatric patients undergoing posterior instrumented craniocervical fusion. In our series, we found an acceptable safety profile, with no seroma, surgical site infection, return to the OR, or rib harvest complication.

Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes.

Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). Rhinoplasty. 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 .

Fresh Frozen Homologous Rib Cartilage: A Narrative Review of a New Trend in Rhinoplasty.

Background: Revision rhinoplasty is a technically demanding surgical procedure that can put every surgeon in trouble. The main issue of these cases is often an altered osteocartilaginous framework following over-resection during the first intervention. Moreover, the available septal or auricular cartilage for grafting is usually not enough. This review aims to examine contemporary advances in applications of fresh frozen cartilage in rhinoplasty. Methods: A structured review of the current literature (up to December 2023) was performed on four bibliographic databases: PubMed, EMBASE, Cochrane and Medline. The search terms were combinations of "Rhinoplasty" and "Cartilage Graft", "Allograft" or "Fresh Frozen Cartilage". The citations of selected studies and review articles were also evaluated if present. Results: The research resulted in 152 articles, and only ten met the inclusion criteria: nine clinical articles and one in vitro study. One of the ten eligible articles was excluded. Conclusions: Fresh frozen rib cartilage proved to be a viable alternative to autologous rib grafts and irradiated homologous rib graft. Despite the higher costs, FFRG can provide a sufficient amount of tissue for grafting avoiding donor site complications and reducing the operative time and proved to have more chondrocytes and to be less prone to resorption compared to irradiated rib.

Operative treatment of calcified thoracic disc herniation: A case report on natural fusion method following spinal canal decompression

Introduction. The literature describes several ways to approach the thoracic spinal segment, but there are still many dilemmas regarding what is best to do after a complete discectomy, regardless of the surgical approach chosen. The incidence of postoperative kyphosis is higher if a posterior surgical approach to the spine is performed, and there are no clearly defined indications for the application of intervertebral fusion (IF) after an anterior approach. The aim of the paper was to highlight the low morbidity of the transthoracic multidisciplinary approach, as well as a potential solution for a good, natural IF of the adjacent vertebrae without expanding and pro-longing the duration of the surgical procedure itself. Case report. A 44-year-old woman presented with severe anterior compressive myelopathy caused by a calcified thoracic disc herniation in the space between the T10-11 vertebrae. A minimally invasive, open, transthoracic approach was performed with decompression of the spinal canal at the specified level and IF was achieved with an autologous rib graft during the same procedure. Despite the relatively low incidence of postoperative spinal instability, one should not overlook a good chance to achieve IF and prevent long-term complications. A control examination of the thoracolumbar segment using the magnetic resonance imaging showed that there is no more compression of the spinal cord and also showed a good IF without an increase in the level of kyphosis. Conclusion. Significant thoracic disc herniation is a rare and challenging surgical lesion. The anterior mini-open transthoracic approach provides good exposure to the relevant structures and is considered minimally invasive. The benefits of subsequent IF after the transthoracic surgical approach should always be taken into account for each individual patient, thus minimalizing the post-operative morbidity.

Database Review of 514 Patients with Os Odontoideum. Detailed Analysis of 258 Surgically Treated (1978-2019).

Database review (1978-2019) is to identify the cause of os odontoideum, its presentation, associated abnormalities, and management recommendations. Review of referral database of 514 patients and 258 surgically treated patients ages 4-64years. Detailed history of early childhood trauma and initial encounter record retrieval were made. Patients had dynamic motion radiographs, dynamic motion MRI and also CT to identify pathology and reducibility of craniocervical instability. Preoperative crown halo traction was made before the year 2000 except in children. Intraoperative traction with O-arm/CT documentation was made since 2001. Reducible and partially reducible cases underwent halo traction under general anesthesia distraction, dorsal stabilization, and rib graft augmentation for fusion. Later semi-rigid instrumentation and subsequently rigid instrumentation was made. Irreducible compression of cervicomedullary junction was treated with ventral decompression. The follow up was 3-20years. Database; acute worsening after trauma 262, insidious neurological deficit 252. Minimal/normal motion with neurological deficit was present in 18, previous C1-C2 fusion with worsening in 18. 28 patients of 64 without treatment worsened in 4years. An intact odontoid process was seen in 52 children of 156 who had early craniovertebral junction trauma and later developed os odontoideum. There were 174 patients with reducible lesions and partially reducible were 22. Irreducible lesions were 62. Of the reducible, 50 underwent transarticular C1-C2 fusion, 26 C1 lateral mass, and C2 pars screw fixation. 182 had occipitocervical fusion (19 had extension of previous C1-C2 fusion and 43 after transoral decompression). 62 with irreducible ventral compression of the cervicomedullary junction underwent transoral decompression; 43 had a trapped transverse ligament between the os and C2 body and 19 previous C1-C2 fusions. Compression was by the axis body, os odontoideum, and the posterior C2 arch. Syndromic and skeletal/connective tissue abnormalities were found in 86 (36%). 2 patients worsened, age 10 and 62, due to failure of semi-rigid construct. The etiology of os odontoideum is multifactorial considering the associated abnormalities, reports of congenital-familiar occurrence, and early childhood craniovertebral trauma which also plays a role in the etiology. Patients with reducible lesions require stabilization. Asymptomatic patients are at risk for later instability. Patients who underwent childhood C1-C2 fusion must be followed for later problems. The irreducibility was seen due to trapped transverse ligament, pannus, or previous dorsal C1-C2 fusion.

Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes

ObjectiveTo compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis.MethodsThis retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up.ResultsThe mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05).ConclusionsMulti-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.

Anterior Chest Wall Reconstruction After Separation of Thoraco-Omphalopagus Conjoined Twins With Cadaveric Rib Grafts and Omental Flap

Background Anterior chest wall defects have a wide range of etiologies in the pediatric population, ranging from infection, tumor, and trauma to congenital diseases. The reconstructive goals include restoring skeletal stability, obliterating dead space, preserving cardiopulmonary mechanics, and protecting vital underlying mediastinal organs. Although various reconstructive methods have been described in the literature, selecting the optimal method is challenging for the growing pediatric skeleton. Here, we report a case of previously thoraco-omphalopagus twins who underwent successful separation and reconstruction and presented for definitive anterior chest wall reconstruction. Methods A pair of previously thoraco-omphalopagus conjoined twins underwent definitive anterior chest wall defect reconstruction using cadaveric ribs and omental flap. Twin A received 2 cadaveric ribs, whereas twin B had a much larger sternal defect that required 3 cadaveric ribs combined with an omental flap for soft tissue chest coverage. Both twins were followed up for 8 months. Results Twin A's postoperative course was uneventful, and she was discharged on postoperative day 6. Twin B's course was complicated, and she was discharged on supported ventilation on postoperative day 10. At 8 months postoperatively, both twins healed well, and chest radiographs confirmed the stability of the chest reconstructions. The rib grafts in the twin with a tracheostomy were not mobile, and the patient had a solid sternum with adequate pulmonary expansion. The construct initially did not facilitate pulmonary functioning, but after a healing process, it eventually allowed for the twin with the tracheostomy who required pulmonary assistance to no longer need this device. Conclusions Cryopreserved cadaveric ribs and omental flaps offer safe and reliable reconstructive methods to successfully reconstruct congenital anterior chest wall skeletal defects in the growing pediatric population. The involvement of multidisciplinary team care is key to optimizing the outcomes.

AUTOGENOUS RIB GRAFT FOR NASAL RECONSTRUCTION, PANORAMIC REVISION

Introduction: It is remarkable the increase in the last decades of rhinoplasties for aesthetic and functional reasons. Some congenital, iatrogenic or traumatic etiologies originate a deficient or deformed nasal dorsum that needs correction with a dorsal augmentation. A deficient osteocartilaginous dorsum is the most frequent drawback requiring augmentation with graft material. Objective: to detail the current information related to autogenous rib grafting for nasal reconstruction. Methodology: a total of 33 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 24 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, SciELO, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: graft, autologous, rhinoplasty, costal, nose, deformity. Results: Costal cartilage is a remarkable material in reconstructive septorhinoplasty, mainly in revision surgery because it requires large amounts of tissue. This autologous material presents a low incidence of complications. With increasing age it is more likely that this cartilage is calcified, so its procurement and manipulation will be more complex. The most commonly used cartilage is the septal cartilage, however, in several cases the septal cartilage may not be sufficient for the intervention, it may be very deteriorated or absent, so the costal cartilage is an essential support for very damaged noses or in case of secondary surgeries. Conclusions: the graft of choice is the septal cartilage due to its simple procurement and physical elastic properties, however its ration is scarce. Rib cartilage is a graft that provides a lot of material. The costal cartilage graft is a fruitful tool when facing complex surgeries or nasal reconstructions. Autologous rib cartilage graft is a viable alternative in reconstructive septorhinoplasty. The surgical technique is not complicated and has a low complication rate. KEY WORDS: autologous graft, rhinoplasty, nasal aesthetics, nasal deformity.