BACKGROUND: Grafting the radix and dorsum of the nose has been controversial and the plastic surgery community has recently revisited diced cartilage grafts. Previous articles by the authors reported clinical failures of diced cartilage-Surgicel-wrapped grafts and the successful implementation of diced cartilage-fascia-wrapped grafts for rhinoplasty procedures. This article investigates four means of radix and dorsum augmentation, including banked and fresh septum. METHODS: Twenty-seven human specimens were taken from rhinoplasty patients: six failed diced cartilage-Surgicel-wrapped grafts, eight diced cartilage-fascia-wrapped grafts, and 13 specimens of fresh cartilage or previously placed cartilage grafts. All were stained with hematoxylin and eosin, Masson's trichrome, safranin-O, glial fibrillary acidic protein, and Evans' van Gieson stains and analyzed for chondrocyte viability, matrix proteins, and regenerative potential of the cartilage. RESULTS: The diced cartilage-Surgicel-wrapped grafts showed disorganized fibrosis, loss of nuclei in chondrocyte lacunae, and negative glial fibrillary acidic protein staining. All specimens contained remnants of Surgicel and evidence of foreign body reaction. The diced cartilage-fascia-wrapped grafts showed normal histologic characteristics, healthy cartilage pieces with viable chondrocytes in their lacunae, positive glial fibrillary acidic protein staining, and organized capsule of fibrosis surrounding the cartilage pieces. The fascia was viable and showed an organized architecture distinctly different from the disorganized scar tissue of the diced cartilage-Surgicel-wrapped grafts. CONCLUSIONS: Given the histologic findings, diced cartilage-Surgicel-wrapped grafts absorbed due to foreign body reaction. Diced cartilage-fascia wrapped grafts survived and demonstrated normal cartilage viability. According to the clinical performance and analysis of these grafts, diced cartilage-fascia is the most reliable way to augment the nasal dorsum and radix with autologous diced cartilage.
BACKGROUND: Grafting the radix and dorsum of the nose has been controversial and the plastic surgery community has recently revisited diced cartilage grafts. Previous articles by the authors reported clinical failures of diced cartilage-Surgicel-wrapped grafts and the successful implementation of diced cartilage-fascia-wrapped grafts for rhinoplasty procedures. This article investigates four means of radix and dorsum augmentation, including banked and fresh septum. METHODS: Twenty-seven human specimens were taken from rhinoplasty patients: six failed diced cartilage-Surgicel-wrapped grafts, eight diced cartilage-fascia-wrapped grafts, and 13 specimens of fresh cartilage or previously placed cartilage grafts. All were stained with hematoxylin and eosin, Masson's trichrome, safranin-O, glial fibrillary acidic protein, and Evans' van Gieson stains and analyzed for chondrocyte viability, matrix proteins, and regenerative potential of the cartilage. RESULTS: The diced cartilage-Surgicel-wrapped grafts showed disorganized fibrosis, loss of nuclei in chondrocyte lacunae, and negative glial fibrillary acidic protein staining. All specimens contained remnants of Surgicel and evidence of foreign body reaction. The diced cartilage-fascia-wrapped grafts showed normal histologic characteristics, healthy cartilage pieces with viable chondrocytes in their lacunae, positive glial fibrillary acidic protein staining, and organized capsule of fibrosis surrounding the cartilage pieces. The fascia was viable and showed an organized architecture distinctly different from the disorganized scar tissue of the diced cartilage-Surgicel-wrapped grafts. CONCLUSIONS: Given the histologic findings, diced cartilage-Surgicel-wrapped grafts absorbed due to foreign body reaction. Diced cartilage-fascia wrapped grafts survived and demonstrated normal cartilage viability. According to the clinical performance and analysis of these grafts, diced cartilage-fascia is the most reliable way to augment the nasal dorsum and radix with autologous diced cartilage.
Authors: S K Singh; Tarun Sood; K Sabarigirish; N Ramakrishnan; Renu Rajguru; K Manoj Kumar Journal: Indian J Otolaryngol Head Neck Surg Date: 2014-12-14