The Turkish delight: A pliable graft for rhinoplasty

In nose surgery, carved or crushed cartilage used as a graft has some disad vantages, chiefly that it may be perceptible through the nasal skin after t issue resolution is complete. To overcome these problems and to obtain a sm oother surface, the authors initiated the use of Surgicel-wrapped diced car tilage. This innovative technique has been used by the authors on 2365 pati ents over the past 10 years: in 165 patients with traumatic nasal deformity , in 350 patients with postrhinoplasty deformity, and in 1850 patients duri ng primary rhinoplasty. The highlights of the surgical procedure include ha rvested cartilage (septal, alar, conchal, and sometimes costal) cut in piec es of 0.5 to 1 mm using a no. 11 blade. The fine-textured cartilage mass is then wrapped in one layer of Surgicel and moistened with an antibiotic (ri famycin). The graft is then molded into a cylindrical form and inserted und er the dorsal nasal skin. In the lateral wall. and tip of the nose, some ov ercorrection is performed depending on the type of deformity. When the muco sal stitching is complete, this graft can be externally molded, like plasti cine, under the dorsal skin. In cases of mild-to-moderate nasal depression, septal and conchal cartilages are used in the same manner to augment the n asal dorsum with consistently effective and durable results. In cases with more severe defects of the nose, costal cartilage is necessary to correct b oth the length of the nose and the projection of the columella. In patients with recurrent deviation of the nasal bridge, this technique provided a si mple solution to the problem. After overexcision of the dorsal part of devi ated septal cartilage and insertion of Surgicel-wrapped diced cartilage, a straight nose was obtained in all patients with no recurrence (follow-up of 1 to 10 years). The technique also proved to be highly effective in primar y rhinoplasties to camouflage bone irregularities after hump removal in pat ients with thin nasal skin and/or in cases when excessive hump removal was performed. As a complication, in six patients early postoperative swelling was more than usual. In 16 patients, overcorrection was persistent owing to fibrosis, and in 11 patients resorption was excessive beyond the expected amount. A histologic evaluation was possible in 16 patients, 3, 6, and 12 m onths postoperatively, by removing thin slices of excess cartilage from the dorsum of the nose during touch-up surgery. This graft showed a mosaic-typ e alignment of graft cartilage with fibrous tissue connection among the fra gments. In conclusion, this type of graft is very easy to apply, because a plasticine-like material is obtained that can be molded with the fingers, g iving a smooth surface with desirable form and long-lasting results in all cases. The favorable results obtained by this technique have led the author s to use Surgicel-wrapped diced cartilage routinely in all types of rhinopl asty.