Can irradiated homologous costal cartilage be safely and reliably utilized as a grafting material for primary and secondary rhinoplasty?
Explore this issue:June 2010
Background: Early reports on irradiated homologous costal cartilage (IHCC) used in nasal grafting were confounded by many factors, making its long-term survivability difficult to assess. Preliminary results from the first large-scale study limiting grafts to nasal reconstruction were encouraging. However, long-term follow-up was necessary to draw further conclusions.
Study Design: Retrospective medical record review
Setting: Single facial plastic surgeon private practice in Houston, Texas
Synopsis: Three hundred fifty-seven patients undergoing primary or revision rhinoplasty utilizing 1,025 IHCC grafts were evaluated for complications during follow-up from four days to 24 years (mean 13.45 years). A 3.25 percent total complication rate resulted from warping in 10 of 941 IHCC grafts (1.06 percent), infection in nine of 1,025 IHCC grafts (0.87 percent), infective resorption in five of 1,025 IHCC grafts (0.48 percent), non-infective resorption in five of 943 (0.53 percent), and graft mobility in three of 941 (0.31 percent). Overall resorption and septal perforation repair associated graft complications were higher with autogenous cartilage (AC) than IHCC grafts with 1.37 percent vs. 1.01 percent and 8 percent vs. 2.46 percent complications, respectively.
Despite the long-term follow-up in a number of patients, only 8 percent were evaluated at >10 years. This limits the ability to refute previous concerns of long term IHCC resorption. IHCC warping is also likely underestimated, with smaller grafts in the nasal tip and other locations more difficult to palpate than non-dorsal onlay grafts. Cartilage grafts such as spreader grafts are placed deep between the upper lateral cartilages and dorsal septum, and any warping would be difficult to assess. This study, however, does demonstrate safety and reliability with IHCC grafts. The authors obtained the IHCC from one of two locations: the University of Texas Health Sciences Center in Dallas, Texas and Northern California Tissue Bank in San Francisco, Calif. The IHCC can be difficult to obtain due to shortages of cadaver donor materials.
Bottom Line: IHCC is a useful grafting material that is safe and can be used effectively when autogenous cartilage is unavailable for primary and secondary rhinoplasty. There is still some question as to the long-term survivability of IHCC.
Citation: Kridel RW, Ashoori F, Lui ES, et. al. Long-term use and follow-up of irradiated homologous costal cartilage grafts in the nose. Arch Facial Plast Surg. 2009;11(6): 378-394.
—Reviewed by Bo Brobst, MD, and Dean M. Toriumi, MD