Q: Dr. Eppley, why is diced cartilage used in rhinoplasty? What is the risk of cartilage graft resorption in the nose? Does diced cartilage resorb less than regular cartilage? In using diced cartilage wrapped in surgicel, I keep coming upon studies showing that when compared to a patient’s fascia, it is much more often reabsorbed, at a much faster and greater rate. I would not like to use fascia just because I don’t feel it is 100% necessary in my case as well as avoiding another part of my body altered for this rhinoplasty. However, I am quite concerned about resorption of these diced cartilage grafts. What would you say would be your estimated percentage of resorption if it were to occur? Rib rhinoplasty is quite a major operation, I would not like to go through such a procedure with an additional scar on my body for an outcome that wasn’t dramatic or only to be reabsorbed down the line.
A: The concept of ‘dicing’ cartilage for rhinoplasty is to make it more malleable, eliminate warping (and the insertion of metal pins into solid grafts to try and avoid that problem) and to avoid excessive pressure on the overlying skin when solid graft is used. The cartilage graft is cut into small 1mm cubes and then placed into a collagen container. (sausage roll) This creates many tiny pores/channels into the graft that allow it to become very quickly revascularized and filled with collagen fibrous tissue which makes it become firm. Whether diced cartilage grafts or solid cartilage grafts have more or less resorption is a matter of debate and there is no clear science that demonstrates that one is necessarily better than the other when it comes to resorption resistance. In theory, the rapid revascularization and nourishing of the diced cartilage would lead to less resorption long-term. As the what causes a graft, of any source and tissue type, to resorb or not is how quickly it can re-establish nourishment. (blood supply) That being said, I have not seen significant resorption with either type of cartilage grafting in the nose.
There is largely one animal study that has created the spin-off of the negative use of Surgicel in diced cartilage grafts. Whether that translates to humans is speculation and has never been proven or shown. Certainly Surgicel is more convenient for the patient as it avoids a donor scalp scar. But when the patient will permit it and is accepting of a temporal scalp scar, the use of one’s own fascia is always a more natural choice that will have less inflammatory response than that of an oxidized cellulose material. It would seem logical that less of an inflammatory response would lower the potential risk of some cartilage graft resorption.
Dr. Barry Eppley