Temporoparietal free fascia grafts in rhinoplasty

The temporoparietal fascial graft provides adequate coverage, contour, and bulk on the cartilage dorsum of the nose, as well as an inconspicuous donor site. In my opinion, this technique not only prevents the occurrence of noticeable sharp edges of the cartilage graft, but also adds to the smooth contour of the reconstructed nasal dorsum. The improved results either in primary and secondary rhinoplasty would seem to justify this technique. Some variations in fascia grafts are presented with clinical examples.     

Frequently used grafts in rhinoplasty: nomenclature and analysis

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Accurately name the most frequently used grafts in primary and secondary rhinoplasty. 2. Describe the precise anatomical position of each graft. 3. Discuss the clinical indications of each graft. SUMMARY: In this article, the authors present the grafting techniques most commonly used to sculpt the nasal framework in primary and secondary rhinoplasty. The grafts are described in terms of their nomenclature, anatomical location, and clinical indications, presenting a simple and easy-to-reference guide for both beginners and expert surgeons.     

Human polymer-based cartilage grafts for the regeneration of articular cartilage defects

The use of autologous chondrocyte implantation (ACI) and its further development combining autologous chondrocytes with bioresorbable matrices may represent a promising new technology for cartilage regeneration in orthopaedic research. Aim of our study was to evaluate the applicability of a resorbable three-dimensional polymer of pure polyglycolic acid (PGA) for the use in human cartilage tissue engineering under autologous conditions. Adult human chondrocytes were expanded in vitro using human serum and were rearranged three-dimensionally in human fibrin and PGA. The capacity of dedifferentiated chondrocytes to re-differentiate was evaluated after two weeks of tissue culture in vitro and after subcutaneous transplantation into nude mice by propidium iodide/fluorescein diacetate (PI/FDA) staining, scanning electron microscopy (SEM), gene expression analysis of typical chondrocyte marker genes and histological staining of proteoglycans and type II collagen. PI/FDA staining and SEM documented that vital human chondrocytes are evenly distributed within the polymer-based cartilage tissue engineering graft. The induction of the typical chondrocyte marker genes including cartilage oligomeric matrix protein (COMP) and cartilage link protein after two weeks of tissue culture indicates the initiation of chondrocyte re-differentiation by three-dimensional assembly in fibrin and PGA. Histological analysis of human cartilage tissue engineering grafts after 6 weeks of subcutaneous transplantation demonstrates the development of the graft towards hyaline cartilage with formation of a cartilaginous matrix comprising type II collagen and proteoglycan. These results suggest that human polymer-based cartilage tissue engineering grafts made of human chondrocytes, human fibrin and PGA are clinically suited for the regeneration of articular cartilage defects.     

Ear cartilage grafts to the nose.

We present our experience in the treatment of secondary nasal deformities caused by excessive resection of the nasal dorsum. We have used ear cartilage autografts, with good results and (on the whole) little or no resorption (some have been followed for 10 years). We consider it essential to correctly shape the transplant and to hold it firmly in the proper position for a period of not less than one week.     

Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage

We describe our experience with autogenous septal cartilage onlay grafts for augmentation of the nasal dorsum in primary and secondary rhinoplasty cases. After careful nasofacial analysis, the grafts are custom-shaped into inverted-V-frame, A-frame, or inverted-U-frame grafts, depending on the type and degree of augmentation desired. The dorsal elevation is thus tailored to fit the imperfection at hand, resulting in a smooth, natural-looking nasal contour. The indications for each type of graft are reviewed, and the surgical technique of graft harvesting and carving is detailed and illustrated.     

Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.