Bhat Uday, Garg Sanchit, D'Souza Eulalia J, Agarkhedkar Nikhil, Singh Ibohal Akoijam, Baliarsing Amresh S
Department of Plastic Surgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
Indian J Plast Surg. 2014 Jan;47(1):25-35. doi: 10.4103/0970-0358.129620.
Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. "Warping" can also be utilized to change the curvature of the graft.
We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.
All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.
The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.
当鼻中隔软骨或耳甲软骨不足以满足隆鼻术中大量需求时，自体肋软骨是一个很好的选择。不愿使用肋软骨是因为担心其发生弯曲变形。然而，如果遵循吉布森（Gibson）和戴维斯（Davis）所倡导的平衡截面原则，弯曲变形是可以避免的。“弯曲变形”也可用于改变移植物的曲率。
在过去10年中，我们在31例患者的隆鼻术中使用了69块肋软骨移植物作为实体块进行轮廓填充。在雕刻移植物时遵循了吉布森和戴维斯所倡导的平衡截面原则，但也让一些移植物发生弯曲变形以获得不同的尺寸和形状。
所有手术均顺利进行。所有患者的美学外观均令人满意且患者均可接受。在2例患者中，鼻背移植物轻微向一侧移位，但仍保持笔直。在1例患者中，后期出现了变形。
软骨弯曲变形的方式是可预测的，并且可以加以利用。担心使用肋软骨移植物是没有道理的，因为通过精确雕刻可以获得所需的形状。
