Linda N Lee1, Kofi D Boahene. 1. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
IMPORTANCE: Transforming a block of costal cartilage into a complex 3-dimensional framework that reflects the contours of a normal ear or nasal bridge requires the creation of many subtle curves, concavities, and convexities. Thus, specialized instruments for microtia repair and rhinoplasty, with specifically curved sharp blades, are used for delicate carving without the need for excessive force, which can damage the framework. Several challenges are associated with these specialized instruments. OBJECTIVE: To describe a novel alternate technique using disposable skin punch biopsy instruments for sculpting cartilage, which have the potential to decrease cost, ensure consistently sharp blades, and provide a variety of sizes to allow precise, controlled contour changes. DESIGN: Surgical technique adapting a commercially available skin punch tool for costocondral sculpting. SETTING: Academic tertiary care medical center. PARTICIPANTS: Patients undergoing microtia repair and rhinoplasty requiring sculpting of costocondral cartilage. MAIN OUTCOMES AND MEASURES: Feasibility and reliability of cartilage contouring. RESULTS: This novel technique has been used in microtia repair and rhinoplasty with excellent results. CONCLUSIONS AND RELEVANCE: This alternate technique of costocondral sculpting should be included as an additional tool in the reconstructive surgeon's armamentarium. LEVEL OF EVIDENCE: NA.
IMPORTANCE: Transforming a block of costal cartilage into a complex 3-dimensional framework that reflects the contours of a normal ear or nasal bridge requires the creation of many subtle curves, concavities, and convexities. Thus, specialized instruments for microtia repair and rhinoplasty, with specifically curved sharp blades, are used for delicate carving without the need for excessive force, which can damage the framework. Several challenges are associated with these specialized instruments. OBJECTIVE: To describe a novel alternate technique using disposable skin punch biopsy instruments for sculpting cartilage, which have the potential to decrease cost, ensure consistently sharp blades, and provide a variety of sizes to allow precise, controlled contour changes. DESIGN: Surgical technique adapting a commercially available skin punch tool for costocondral sculpting. SETTING: Academic tertiary care medical center. PARTICIPANTS: Patients undergoing microtia repair and rhinoplasty requiring sculpting of costocondral cartilage. MAIN OUTCOMES AND MEASURES: Feasibility and reliability of cartilage contouring. RESULTS: This novel technique has been used in microtia repair and rhinoplasty with excellent results. CONCLUSIONS AND RELEVANCE: This alternate technique of costocondral sculpting should be included as an additional tool in the reconstructive surgeon's armamentarium. LEVEL OF EVIDENCE: NA.
Authors: Christopher D Lopez; Lukasz Witek; Andrea Torroni; Roberto L Flores; David B Demissie; Simon Young; Bruce N Cronstein; Paulo G Coelho Journal: Birth Defects Res Date: 2018-05-20 Impact factor: 2.344