Clinical Review & Education
Surgical Pearls
A Single Incision for Harvesting Conchal Cartilage and Temporal Fascia in Diced Cartilage–Fascia Grafts Sarju S. Vasani, FRCS(ORL-HNS); Rajesh Anmolsingh, MBBS; Ivor Kwame, MRCS; Charles East, FRCS
Rhinoplasty surgery using diced cartilage grafts has been modified several times since its inception. The “Turkish delight” technique developed by Erol1 includes the insertion of diced cartilage wrapped in Surgicel (Ethicon Inc). However Calvert et al2 reported that graft absorption frequently ensued. Daniel3 therefore recommended Video at the use of a deep temporal fasjamafacialplasticsurgery.com cia wrapper creating a diced cartilage–fascia (DCF) graft instead of Surgicel.3 This modification led to grafts maintaining longer chondrocyte viability.4,5 The use of temporal fascia has the disadvantage of requiring a further incision, which is not necessary if using Surgicel or autologous tissue glue.6 We aimed to introduce a modified single incision for harvesting both conchal cartilage graft and temporal fascia, with the objective of improving the aesthetic outcome of the procedure as well as reducing perioperative time. This technique is particularly useful in secondary rhinoplasty surgery, where septal cartilage may be in short supply.
Surgical Technique We present a Video describing and illustrating the process of nasal augmentation using a DCF graft. The procedure shown has been performed on a patient with a repaired cleft palate and was carried out via an open septorhinoplasty approach with an asymmetric incision for V-Y lengthening of left nostril.
The success of dorsal nasal augmentation is measured by the aesthetic outcome as well as the survivability of the graft. Autologous grafts have distinct advantages over nonautologous grafts— they have greater longevity and simultaneously provide a natural contour without the complications related to biocompatibility. Other advantages include the ready availability from the patient, lower rate of infections, and potential extrusion of synthetic graft.6 The long-term outcome of Erol’s “Turkish delight” technique1 was disputed by Calvert et al2 who concluded that Surgicel has a deleterious effect on the viability of diced cartilage. These points give heavy weighting to the use of fascia as a wrapper in dorsal augmentation. The approximately 3-cm transverse incision over the temporal fascia harvest site 3 can be in addition to that incision used to harvest costochondral or auricular cartilage. The reduced number of incisions in this technique therefore decreases extra complications of an additional wound including scarring, pain, infection, and dehiscence. The site of incision also increases the aesthetic value because the cranial aspect can be well hidden under the hairline as well as behind the ear. We wish to add to the current practice of diced cartilage with fascial grafting by offering this modified incision technique. We believe that this is a useful and worthwhile adaptation.
Conflict of Interest Disclosures: None reported.
ARTICLE INFORMATION Author Affiliations: Royal National Throat, Nose and Ear Hospital, London, England (Vasani, Anmolsingh, Kwame, East); University College London Hospitals NHS Trust, London, England (East).
374
Discussion
REFERENCES 1. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg. 2000;105(6): 2229-2242.
Corresponding Author: Sarju S. Vasani, FRCS(ORL-HNS), Royal National Throat, Nose and Ear Hospital, 330 Gray’s Inn Rd, London WC1X 8DA, England ([email protected]).
2. Calvert JW, Brenner K, DaCosta-Iyer M, Evans GR, Daniel RK. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg. 2006;118(1): 230-236.
Published Online: June 19, 2014. doi:10.1001/jamafacial.2014.234.
3. Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg. 2008;122(6):1883-1891.
4. Brenner KA, McConnell MP, Evans GRD, Calvert JW. Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg. 2006;117(1):105-115. 5. Coskun BU, Seven H, Yigit O, et al. Comparison of diced cartilage graft wrapped in surgicell and diced cartilage graft wrapped in fascia: an experimental study. Laryngoscope. 2005;115(4):668-671. 6. Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg. 2011;35(4):569-579.
JAMA Facial Plastic Surgery September/October 2014 Volume 16, Number 5
Copyright 2014 American Medical Association. All rights reserved.
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jamafacialplasticsurgery.com
Surgical Pearls
A Single Incision for Harvesting Conchal Cartilage and Temporal Fascia in Diced Cartilage–Fascia Grafts Sarju S. Vasani, FRCS(ORL-HNS); Rajesh Anmolsingh, MBBS; Ivor Kwame, MRCS; Charles East, FRCS
Rhinoplasty surgery using diced cartilage grafts has been modified several times since its inception. The “Turkish delight” technique developed by Erol1 includes the insertion of diced cartilage wrapped in Surgicel (Ethicon Inc). However Calvert et al2 reported that graft absorption frequently ensued. Daniel3 therefore recommended Video at the use of a deep temporal fasjamafacialplasticsurgery.com cia wrapper creating a diced cartilage–fascia (DCF) graft instead of Surgicel.3 This modification led to grafts maintaining longer chondrocyte viability.4,5 The use of temporal fascia has the disadvantage of requiring a further incision, which is not necessary if using Surgicel or autologous tissue glue.6 We aimed to introduce a modified single incision for harvesting both conchal cartilage graft and temporal fascia, with the objective of improving the aesthetic outcome of the procedure as well as reducing perioperative time. This technique is particularly useful in secondary rhinoplasty surgery, where septal cartilage may be in short supply.
Surgical Technique We present a Video describing and illustrating the process of nasal augmentation using a DCF graft. The procedure shown has been performed on a patient with a repaired cleft palate and was carried out via an open septorhinoplasty approach with an asymmetric incision for V-Y lengthening of left nostril.
The success of dorsal nasal augmentation is measured by the aesthetic outcome as well as the survivability of the graft. Autologous grafts have distinct advantages over nonautologous grafts— they have greater longevity and simultaneously provide a natural contour without the complications related to biocompatibility. Other advantages include the ready availability from the patient, lower rate of infections, and potential extrusion of synthetic graft.6 The long-term outcome of Erol’s “Turkish delight” technique1 was disputed by Calvert et al2 who concluded that Surgicel has a deleterious effect on the viability of diced cartilage. These points give heavy weighting to the use of fascia as a wrapper in dorsal augmentation. The approximately 3-cm transverse incision over the temporal fascia harvest site 3 can be in addition to that incision used to harvest costochondral or auricular cartilage. The reduced number of incisions in this technique therefore decreases extra complications of an additional wound including scarring, pain, infection, and dehiscence. The site of incision also increases the aesthetic value because the cranial aspect can be well hidden under the hairline as well as behind the ear. We wish to add to the current practice of diced cartilage with fascial grafting by offering this modified incision technique. We believe that this is a useful and worthwhile adaptation.
Conflict of Interest Disclosures: None reported.
ARTICLE INFORMATION Author Affiliations: Royal National Throat, Nose and Ear Hospital, London, England (Vasani, Anmolsingh, Kwame, East); University College London Hospitals NHS Trust, London, England (East).
374
Discussion
REFERENCES 1. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg. 2000;105(6): 2229-2242.
Corresponding Author: Sarju S. Vasani, FRCS(ORL-HNS), Royal National Throat, Nose and Ear Hospital, 330 Gray’s Inn Rd, London WC1X 8DA, England ([email protected]).
2. Calvert JW, Brenner K, DaCosta-Iyer M, Evans GR, Daniel RK. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg. 2006;118(1): 230-236.
Published Online: June 19, 2014. doi:10.1001/jamafacial.2014.234.
3. Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg. 2008;122(6):1883-1891.
4. Brenner KA, McConnell MP, Evans GRD, Calvert JW. Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg. 2006;117(1):105-115. 5. Coskun BU, Seven H, Yigit O, et al. Comparison of diced cartilage graft wrapped in surgicell and diced cartilage graft wrapped in fascia: an experimental study. Laryngoscope. 2005;115(4):668-671. 6. Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg. 2011;35(4):569-579.
JAMA Facial Plastic Surgery September/October 2014 Volume 16, Number 5
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archfaci.jamanetwork.com/ by a University of Georgia User on 06/01/2015
jamafacialplasticsurgery.com
