Plastic Surgery New Jersey

The ideal graft should be readily available in unlimited quantities, be inexpensive, easy to handle and contour, have and retain adequate rigidity, be nonantigenic, and remain intact. It should be easy to remove in the event of a problem such as infection.

Live septal autografts come closest to meeting the ideal graft specifications, except for their limited size and occasional unavailability because of previous surgery.

Figure 1. Photographs of a lateral view of a patient with a poly beak deformity preoperatively (A), 1 year postoperatively after correction with a septal cartilage autograft (B), and 16 years postoperatively (C).

The septum is thickest at its base, providing the best source for a rigid, supporting graft. Superiorly the septum thins and this area supplies a less rigid graft that may be used in alar contour defects. Table I lists the various grafts used in the nose, which include columella strut reinforcement, augmentation of the nasal dorsum, contour defect graft, and tip projection graft.

Merthiolate-stored septal cartilage homograft has been reported as an excellent graft in nasal surgery, persisting over long periods based on clinical observation. Merthiolate is a relatively biocompatible agent and cartilage stored in a 1:1000 solution of clear Merthiolate has been shown to retain its tensile strength up to 130 days.'" Merthiolate, however, is a low-level antiseptic and although excellent for storage cannot be considered an adequate disinfectant.

Live septal homografts, which have been used successfully in the past, have the same physical characteristics as living autografts. The major drawback is the need to check sterility and absence of viral contaminants. An alternative is to subject septal homografts to a cold sterilant such as Alcide (Alcide Corp.) followed by preservation in Merthiolate under sterile conditions.

Rib autografts are rarely used because of the added significant surgical procedure and the tendency to warp. Irradiated rib cartilage is readily available in large sizes, is easy to handle and carve, and does not warp. It is inexpensive and stores well over long periods of time. It is not an ideal graft because of the question of its long-term survival.

Figure 2. An example of use of septal cartilage homograft as a columella strut. Photographs taken preoperatively (A), 6 months postoperatively (B), and 10 years postoperatively (C).

Figure 3. Use of an irradiated rib cartilage to correct saddle nose deformity. Photographs taken preoperatively (A and C) and I year postoperatively (B and I)).

The major drawback of a conchal cartilage autograft is its shape and lack of rigidity, which makes it less desirable as a supporting graft. However, it is very useful as a contour graft.

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