Wei-Cheng Ching1, Yen-Chang Hsiao. 1. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Medical College, Chang Gung University, Taipei, Taiwan.
Abstract
BACKGROUND: The quality and quantity of costal cartilage allow for versatile and stable cartilage supply for various nasal deformities, but the apparent scar on the chest wall can be a major concern in cosmetic surgery of Asians. The authors describe a new method for harvesting costal cartilage by transumbilical endoscopic approach to avoid any scar on the chest wall and to fulfill the requirements of cosmetic procedures. METHODS: An endoscopic retractor paired with a 10-mm and 30-degree down-viewing rigid endoscope is used to harvest the seventh, eighth, and ninth rib cartilage on the right. Elevators and eletrocautery units designed for conventional endoscopic procedures are used for cartilage dissection. Adequate amount of cartilage graft can be obtained through umbilical incision. RESULTS: Eight patients underwent rhinoplasty with costal cartilage harvested using this method. The length of the harvested blocks from the seventh and eighth ribs ranged from 4.5 to 7 cm. The cartilage blocks harvested from the ninth ribs were 2.5 and 3.5 cm in length. The operative time of cartilage harvesting ranged from 2 to 2.5 hours. There were no associated intraoperative complications. In all cases, no signs of pneumothorax were detected after operation. The umbilical wounds healed without significant scarring within 2 weeks. CONCLUSIONS: This technique provides an effective alternative for costal cartilage harvesting with an inconspicuous scar hidden by the umbilicus that can be applied to selective rhinoplasty cases.
BACKGROUND: The quality and quantity of costal cartilage allow for versatile and stable cartilage supply for various nasal deformities, but the apparent scar on the chest wall can be a major concern in cosmetic surgery of Asians. The authors describe a new method for harvesting costal cartilage by transumbilical endoscopic approach to avoid any scar on the chest wall and to fulfill the requirements of cosmetic procedures. METHODS: An endoscopic retractor paired with a 10-mm and 30-degree down-viewing rigid endoscope is used to harvest the seventh, eighth, and ninth rib cartilage on the right. Elevators and eletrocautery units designed for conventional endoscopic procedures are used for cartilage dissection. Adequate amount of cartilage graft can be obtained through umbilical incision. RESULTS: Eight patients underwent rhinoplasty with costal cartilage harvested using this method. The length of the harvested blocks from the seventh and eighth ribs ranged from 4.5 to 7 cm. The cartilage blocks harvested from the ninth ribs were 2.5 and 3.5 cm in length. The operative time of cartilage harvesting ranged from 2 to 2.5 hours. There were no associated intraoperative complications. In all cases, no signs of pneumothorax were detected after operation. The umbilical wounds healed without significant scarring within 2 weeks. CONCLUSIONS: This technique provides an effective alternative for costal cartilage harvesting with an inconspicuous scar hidden by the umbilicus that can be applied to selective rhinoplasty cases.