Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest...Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are equally important factors which influence donor-site deformity in microtia reconstruction.展开更多
Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene(ePTFE)in Asian rhinoplasty were presented in this s...Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene(ePTFE)in Asian rhinoplasty were presented in this study.Objectives The purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.Methods Seventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed.Graft types,complications associated with the graft itself or graft harvesting,surgical outcomes,and patient satisfaction were assessed.Results The mean follow-up time post-operation was 13.5 months.A total of 42/75 patients underwent revision surgeries.Graft-related complications were found in 8%of cases,including two warped graft and four infection cases.Three individuals with infections had mild graft resorption.One patient with an infection removed the implant.Graft exposure,mobility,and substantial resorption were not recorded.A total of two cases underwent revision procedures for infection and perforation,respectively.Chest incision lengths for graft harvesting averaged 2.1 cm.No pneumothorax or significant donor-site pain was found.Donor-site scars were negligible,although two cases had hypertrophic chest scars.In general,functional and esthetic outcomes were mostly satisfactory among the assessed patients.Conclusions Rhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring.Meanwhile,ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes.Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent,long-lasting results with minimal risk;however,the potential for infection should be considered following revision surgery.展开更多
Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia r...Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia reconstruction in our hospital were selected,all of whom were type II or type III pediatric deformities.All patients underwent auricle reconstruction and retroauricular skin expansion and autologous costal cartilage stent.The first stage of the operation is to insert a skin dilator behind the residual ear and inject water to expand.The second stage of the operation is to carve and repair the soft ribs(usually 6 or 7 ribs)from the body,make a three-dimensional auricle support for auricle reconstruction,place a negative pressure drainage tube,and follow up for 3 to 6 months to observe the three-dimensional shape of the reconstructed auricle and the formation of cranioauricular angle.Results 41 patients with microtia had good three-dimensional shape of auricle reconstruction,normal auricle position,moderate cranioauricular angle,good helix and triangular fossa structure,and good bilateral symmetry.Patients and their families were satisfied with the effect of auricle reconstruction.Conclusion Autologous costal cartilage is a good scaffold for auricle reconstruction.It is through efficient and elaborate carving and splicing that a good three-dimensional auricle structure can be formed.Combined with early flap expansion,a good postoperative appearance effect can be obtained,which is the appropriate method for auricle reconstruction at present.展开更多
On account of the poor biocompatibility of synthetic prosthesis,millions of rhinoplasty recipients have been forced to choose autologous costal cartilage as grafts,which suffer from limited availability,morbidity at t...On account of the poor biocompatibility of synthetic prosthesis,millions of rhinoplasty recipients have been forced to choose autologous costal cartilage as grafts,which suffer from limited availability,morbidity at the donor site and prolonged operation time.Here,as a promising alternative to autologous costal cartilage,we developed a novel xenogeneic costal cartilage and explored its feasibility as a rhinoplasty graft for the first time.Adopting an improved decellularization protocol,in which the ionic detergent was substituted by trypsin,the resulting decellularized graft was confirmed to preserve more structural components and better mechanics,and eliminate cellular components effectively.The in vitro and in vivo compatibility experiments demonstrated that the decellularized graft showed excellent biocompatibility and biosecurity.Additionally,the functionality assessment of rhinoplasty was performed in a rabbit model,and the condition of grafts after implantation was comprehensively evaluated.The optimized graft exhibited better capacity to reduce the degradation rate and maintain the morphology,in comparison to the decellularized costal cartilage prepared by conventional protocol.These findings indicate that this optimized graft derived from decellularized xenogeneic costal cartilage provides a new prospective for future investigations of rhinoplasty prosthesis and has great potential for clinical application.展开更多
Autologous costal cartilage is an excellent source of graft in rhinoplasty due to its rich supply,durability,versatility,and functionality.For a long time,rhinoplasty surgeons have been critical of using autologous co...Autologous costal cartilage is an excellent source of graft in rhinoplasty due to its rich supply,durability,versatility,and functionality.For a long time,rhinoplasty surgeons have been critical of using autologous costal cartilage based on the potential for associated complications including donor site morbidities,postoperative pain,warping,and long operation time.Even with this criticism,costal cartilage is still a gra昀material of choice in cartilage depleting revision rhinoplasty.Recently,there has been a steady increase in costal cartilage use even in primary augmentation rhinoplasty,especially in Asian.展开更多
文摘Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are equally important factors which influence donor-site deformity in microtia reconstruction.
基金This work was supported by Key Clinical Projects of Peking University Third Hospital(No.BYSYZD2019013)the Scientific Research Staring Foundation for the Returned Overseas Chinese Scholars,Peking University Third Hospital(No.BYSYLXHG2019001).
文摘Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene(ePTFE)in Asian rhinoplasty were presented in this study.Objectives The purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant.Methods Seventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed.Graft types,complications associated with the graft itself or graft harvesting,surgical outcomes,and patient satisfaction were assessed.Results The mean follow-up time post-operation was 13.5 months.A total of 42/75 patients underwent revision surgeries.Graft-related complications were found in 8%of cases,including two warped graft and four infection cases.Three individuals with infections had mild graft resorption.One patient with an infection removed the implant.Graft exposure,mobility,and substantial resorption were not recorded.A total of two cases underwent revision procedures for infection and perforation,respectively.Chest incision lengths for graft harvesting averaged 2.1 cm.No pneumothorax or significant donor-site pain was found.Donor-site scars were negligible,although two cases had hypertrophic chest scars.In general,functional and esthetic outcomes were mostly satisfactory among the assessed patients.Conclusions Rhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring.Meanwhile,ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes.Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent,long-lasting results with minimal risk;however,the potential for infection should be considered following revision surgery.
文摘Objective To investigate the application effect and manufacturing skills of autologous costal cartilage scaffold in ear reconstruction for microtia.Methods From January 2016 to January 2019,41 patients with microtia reconstruction in our hospital were selected,all of whom were type II or type III pediatric deformities.All patients underwent auricle reconstruction and retroauricular skin expansion and autologous costal cartilage stent.The first stage of the operation is to insert a skin dilator behind the residual ear and inject water to expand.The second stage of the operation is to carve and repair the soft ribs(usually 6 or 7 ribs)from the body,make a three-dimensional auricle support for auricle reconstruction,place a negative pressure drainage tube,and follow up for 3 to 6 months to observe the three-dimensional shape of the reconstructed auricle and the formation of cranioauricular angle.Results 41 patients with microtia had good three-dimensional shape of auricle reconstruction,normal auricle position,moderate cranioauricular angle,good helix and triangular fossa structure,and good bilateral symmetry.Patients and their families were satisfied with the effect of auricle reconstruction.Conclusion Autologous costal cartilage is a good scaffold for auricle reconstruction.It is through efficient and elaborate carving and splicing that a good three-dimensional auricle structure can be formed.Combined with early flap expansion,a good postoperative appearance effect can be obtained,which is the appropriate method for auricle reconstruction at present.
基金supported by Sichuan Science and Technology Program(2020YFH0008)National Natural Science Foundation of China(No.81771351)+1 种基金Joint Research Fund Liaoning-Shenyang National Laboratory for Materials Science(2019JH3/30100022)National Key R&D Program of China(2017YFA0105802).
文摘On account of the poor biocompatibility of synthetic prosthesis,millions of rhinoplasty recipients have been forced to choose autologous costal cartilage as grafts,which suffer from limited availability,morbidity at the donor site and prolonged operation time.Here,as a promising alternative to autologous costal cartilage,we developed a novel xenogeneic costal cartilage and explored its feasibility as a rhinoplasty graft for the first time.Adopting an improved decellularization protocol,in which the ionic detergent was substituted by trypsin,the resulting decellularized graft was confirmed to preserve more structural components and better mechanics,and eliminate cellular components effectively.The in vitro and in vivo compatibility experiments demonstrated that the decellularized graft showed excellent biocompatibility and biosecurity.Additionally,the functionality assessment of rhinoplasty was performed in a rabbit model,and the condition of grafts after implantation was comprehensively evaluated.The optimized graft exhibited better capacity to reduce the degradation rate and maintain the morphology,in comparison to the decellularized costal cartilage prepared by conventional protocol.These findings indicate that this optimized graft derived from decellularized xenogeneic costal cartilage provides a new prospective for future investigations of rhinoplasty prosthesis and has great potential for clinical application.
文摘Autologous costal cartilage is an excellent source of graft in rhinoplasty due to its rich supply,durability,versatility,and functionality.For a long time,rhinoplasty surgeons have been critical of using autologous costal cartilage based on the potential for associated complications including donor site morbidities,postoperative pain,warping,and long operation time.Even with this criticism,costal cartilage is still a gra昀material of choice in cartilage depleting revision rhinoplasty.Recently,there has been a steady increase in costal cartilage use even in primary augmentation rhinoplasty,especially in Asian.
