Brenner Kevin A, McConnell Michael P, Evans Gregory R D, Calvert Jay W
Aesthetic and Plastic Surgery Institute, University of California, Irvine, California, USA.
Plast Reconstr Surg. 2006 Jan;117(1):105-15. doi: 10.1097/01.prs.0000195082.38311.f4.
Use of diced cartilage grafts in rhinoplasty surgery has recently undergone a dramatic resurgence. Some authors recommend wrapping diced cartilage with oxidized methylcellulose (i.e., Surgicel). Others prefer wrapping diced cartilage with autogenous deep temporal fascia. This study was designed to compare the behavior of diced cartilage grafts as an isolated entity or when wrapped with either Surgicel or deep temporal fascia.
Septal cartilage and deep temporal fascia were obtained from five patients in this institutional review board-approved study. The cartilage was diced into 0.5-mm pieces and implanted into subcutaneous dorsal skin pockets of Rowlett nude rats as isolated diced cartilage grafts, or wrapped in Surgicel or deep temporal fascia. Pieces of Surgicel and fascia were implanted alone as controls. The specimens were harvested at 8 weeks; processed by thin-section histology; stained with hematoxylin and eosin, Masson's trichrome, glial fibrillary acidic protein, safranin-O, and Evans van Gieson; and evaluated to determine cartilage viability and architectural characteristics.
Diced cartilage wrapped in Surgicel yielded the lowest percentage viability and minimal staining with hematoxylin and eosin, trichrome tissue, safranin-O, and Evans van Gieson stains. Diced cartilage grafts wrapped in fascia had the greatest percentage of viable cartilage. The grafts wrapped in deep temporal fascia also demonstrated the strongest staining with the aforementioned stains. Differences in uptake of glial fibrillary acidic protein were not noticeable between the three groups. However, absolute numbers of nucleated lacunae and basophilic lacunae were significantly higher for grafts wrapped in deep temporal fascia.
Diced cartilage grafts have reemerged as a viable method for nasal reconstruction in both primary and secondary rhinoplasty. Wrapping diced cartilage specimens contains the individual pieces and facilitates graft placement. Surgicel wraps appear to incite an inflammatory response and subsequent absorption of the cartilage. Fascia wraps appear to minimize inflammatory responses to the cartilage, thereby preserving healthy cartilage. This study demonstrates that deep temporal fascia is the preferred envelope with which to facilitate graft containment and maintain chondrocyte viability of diced cartilage grafts.
在鼻整形手术中，碎软骨移植的应用最近经历了戏剧性的复兴。一些作者建议用氧化甲基纤维素（即 Surgicel）包裹碎软骨。另一些人则倾向于用自体颞深筋膜包裹碎软骨。本研究旨在比较碎软骨移植作为独立实体时，以及用 Surgicel 或颞深筋膜包裹时的表现。
在这项经机构审查委员会批准的研究中，从 5 名患者身上获取鼻中隔软骨和颞深筋膜。将软骨切成 0.5 毫米的小块，作为单独的碎软骨移植片植入罗利特裸鼠皮下背部皮肤袋中，或用 Surgicel 或颞深筋膜包裹。单独植入 Surgicel 和筋膜片作为对照。8 周后取出标本；通过薄切片组织学处理；用苏木精和伊红、马松三色染色、胶质纤维酸性蛋白、番红 O 和伊文思凡吉森染色；并进行评估以确定软骨活力和结构特征。
用 Surgicel 包裹的碎软骨活力百分比最低，苏木精和伊红、三色组织、番红 O 和伊文思凡吉森染色的染色最少。用筋膜包裹的碎软骨移植片中存活软骨的百分比最高。用颞深筋膜包裹的移植片在上述染色中也显示出最强的染色。三组之间胶质纤维酸性蛋白摄取的差异不明显。然而，用颞深筋膜包裹的移植片中有核腔隙和嗜碱性腔隙的绝对数量明显更高。
碎软骨移植已重新成为初次和二次鼻整形中可行的鼻再造方法。包裹碎软骨标本可容纳各个碎片并便于移植放置。Surgicel 包裹似乎会引发炎症反应并随后导致软骨吸收。筋膜包裹似乎能将对软骨的炎症反应降至最低，从而保留健康的软骨。本研究表明，颞深筋膜是促进移植片容纳并维持碎软骨移植片软骨细胞活力的首选包膜。
