K. Ohara et al., CHEST-WALL DEFORMITIES AND THORACIC SCOLIOSIS AFTER COSTAL CARTILAGE GRAFT HARVESTING, Plastic and reconstructive surgery, 99(4), 1997, pp. 1030-1036
Donor-site complications, specifically chest wall deformities and thor
acic scoliosis, occurring after harvest of costal cartilage grafts are
presented and discussed. The cases of 18 patients (12 male and 6 fema
le), who underwent costal cartilage grafts for microtia reconstruction
from 1975 to 1993, were reviewed for donor-site complications using r
adiography and physical examination. Ribs from which costal cartilage
had been harvested showed increased inward bowing on radiographs in 16
of 32 donor sites. The frequency of rib deformity in donor sites was
20.0 percent when cartilages were harvested from patients older than 1
0 years of age, whereas it was 63.6 percent in patients younger than 1
0 years old. This difference was statistically significant (p = 0.027,
Fisher's exact test), although only 32 grafts were performed in 18 ca
ses. The upper ribs demonstrate a higher incidence of deformity than l
ower ribs. Thoracic scoliosis was found in 4 of 16 cases. The biomecha
nical impact of these deformities was considered because of respirator
y movement of the thorax and injury to the germinal growth center of t
he ribs. We recommend delaying costal cartilage grafts for as long as
possible, leaving the costochondral junction intact to minimize chest
wall deformity and thoracic scoliosis.