A Technique to Prevent Warping of Costochondral Grafts in Nasal Surgery

Introduction: Costal cartilage is commonly used in nasal reconstruction due to its strength and biocompatibility; however, warping of carved struts remains a challenge. The author describes a surgical technique of harvesting grafts that yields multiple straight non-warping strut grafts ideal for use in nasal reconstruction. Previous work carried out by our group explains the observed reliability of these grafts based on the microstructure of this unique ubiquitous anatomic feature. Methods: The principles of balanced cross-sectional forces and the mechanical basis of the success of this technique in consistently yielding non-warping grafts is reviewed. The technique exploits this microstructural equilibrium by harvesting transverse (axial) sections from the anatomically unique sixth seventh costochondral synchondrosis. The latter is a normal anatomic feature of the thoracic cage. The surgical method is described in detail with accompanying videos and figures. An expert assessment comparing early and late post operative results is presented to support clinical stability and minimal to no warp over time. Results: The author has utilized this technique for more than 10 years in over 100 nasal reconstructive cases. The technique is reproducible and reliable but requires an understanding of the microstructure of the sixth seventh synchondrosis to ensure proper sectioning with optimal results. In comparing early and late results, a High-level clinical stability was maintained across the study cohort, with 92.5% (n = 37/40) of all independent evaluations indicating either absolute stability or clinically insignificant change (grades 0 or 1). Complete absence of change (grade 0) comprised 67.5% (n = 27/40) of all evaluations. Conclusion: The transverse sectioning method of the sixth-seventh costochondral synchondrosis exploits the microstructure of this unique anatomic feature in order to yield multiple consistently non-warping straight struts grafts ideal for nasal reconstruction.