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Rib Cartilage Graft
Rib cartilage grafting (also known as costal cartilage grafting) is one of the workhorses of revision rhinoplasty. Patients presenting for revision rhinoplasty often have problems that require cartilage grafting but in many of those patients there is not adequate cartilage present in the nose to be used as grafting material. Rib cartilage obtained from the patient's own body at the same time as the revision rhinoplasty makes the ideal grafting material for a number of reasons. The procedure to harvest the rib cartilage typically takes 20-30 minutes and requires placing an incision just over an inch on the chest. In women the incision is hidden nicely in the inframammary fold.
- Rib cartilage grafts are typically available in large quantities when major grafting is needed
- Rib cartilage grafts are structurally strong and can be used to rebuild the entire bridge, lengthen a short nose, and correct deviations in cartilage
- Rib cartilage grafts are natural and obtained from the patients own body
- Rib cartilage grafts are much more resistant to infection and absorption than implants or cadaver rib grafts.
- Rib cartilage grafts require placing an incision on the chest and the chest muscle will be sore for a few weeks
- Rib cartilage grafts can feel somewhat hard and stiff for months although they do soften and feel more natural over time
- Rib cartilage grafts placed on the bridge of the nose can at times curve or 'warp' over time although there are technical modifications to avoid this
Cadaveric rib cartilage grafts are an alternative to autologous (obtained from the patient) rib cartilage grafts but have several significant down sides. Cadaveric rib does not resist infection like autologous rib cartilage does and if an infection occurs the cadaver rib grafts will often resorb (disappear). Cadaver rib also comes with a potential of human-to-human disease transmission.
Implants may at times be used on the bridge instead of rib cartilage but are cursed with the lifetime risk of infection and extrusion.
After rib cartilage grafting the chest will be sore for a few weeks, similar to the feeling after a vigorous work-out. The same pain medications used to treat the discomfort after rhinoplasty are typically adequate for the rib graft donor site as well. At times Valium or similar agents are used to decrease discomfort related to muscle spasms. The incision is repaired with buried sutures and covered with tape such that no wound care is typically required. After rib cartilage grafting you would need to avoid chest (pectoralis) exercises for a few weeks.