Graft-depleted Patient

Chapter 14. Graft-depleted Patient

Indications: There are five potential donor sites for autogenous tissue in secondary (or tertiary) rhinoplasty: ear cartilage, septal cartilage, rib cartilage, and calvarial and iliac bone. Patients who have exhausted the usual donor sites or were unhappy with prior donor procedures may require alternative options. Septal cartilage is optimal because it has strength and is planar, making it easy to shape into grafts that resist warping. Ear cartilage lacks structural support, and rib cartilage is prone to warping and painful as a donor site. Autogenous cartilage is the first choice; however, when supplies are depleted, other options are necessary.

Irradiated cartilage: Irradiated cartilage is abundant and avoids a donor site. Some report that irradiated cartilage resorbs and is prone to warping even up to four weeks after carving.¹ However, the same study showed no difference in warping between irradiated and non-irradiated cartilage. Other studies have demonstrated long-term use with minimal resorption and acceptable warping characteristics.²