Harvesting the Entire Seventh Costal Cartilage for Secondary Rhinoplasty

Overview

As rhinoplasty becomes more common, revision cases are increasing, and these require more cartilage than a first operation. Rib cartilage is considered a good source. The authors describe their method for harvesting the entire seventh rib cartilage, performed from April 2019 to March 2020 in 156 patients.

Sections of note

• Technique description with a series of 156 patients.
• The incision was placed in the fold under the breast in women and directly over the cartilage in men, about 3.5 cm long.
• After the skin incision, the muscle fascia plane was found and wide dissection performed.
• The fascia was opened and the rectus abdominis muscles split to expose the cartilage.
• Careful dissection beneath the perichondrium was carried out all the way around.
• The junction with the bone was cut and dislocated, then the joints with the sixth and eighth cartilages in turn.
• The sternal end was cut last while protecting the underlying perichondrium.
• The chest was checked for air leakage and closed in layers; mean harvest time was 52 minutes and average cartilage length 9.33 mm as stated.

What it means for a patient

• The whole seventh rib cartilage provides the largest single piece available for rebuilding a heavily operated nose.
• The incision is hidden in the breast fold in women.
• No collapsed lung or other complications were reported in 156 harvests.
• The stated average cartilage length of 9.33 mm appears inconsistent with harvesting an entire rib cartilage, so that figure should be treated with caution.

Why this paper matters

Revision rhinoplasty is limited by how much cartilage is available, and rib harvest is the main way to obtain enough. This series documents a method for taking the full segment with no reported chest complications. It reports nothing about how the cartilage performed once placed in the nose.

Terms

• Costal cartilage: cartilage from the rib.
• Perichondrium: the membrane covering cartilage.
• Costochondral junction: where rib cartilage meets rib bone.
• Synchondrosis: a cartilage joint between two adjacent rib cartilages.
• Pneumothorax: air leaking into the chest cavity, which can collapse a lung.
• Inframammary fold: the crease beneath the breast.