Cartilage grafting in rhinoplasty today is often an essential component of the procedure. Improving structural support of the nasal tip and internal nasal valves may require mechanical support through the use of cartilage grafts. In some patients, particularly revisional rhinoplasty patients, cartilage donor sites may have been previously used and the patient is now ‘graft-depleted’. In reality, graft depletion is usually relegated to the septum as ear and rib cartilage donor sites are always available but the plastic surgeon or patient may want to have a seconday donor site harvest.
A most recent article in Plastic and Reconstructive Surgery by British plastic surgeons writes on their successful use of polydioxanone foil in rhinoplasty surgery. Polydioxanone is one of the many biodegradable polymers that exists and has been used for many years in orbital floor fracture repair. It maintains its integrity for about 6 months and is flexible and adaptable. It comes in various thicknesses, usually .25 or .5mm is used. They performed 58 rhinoplasties in which it was implanted. (37 primary, 21 secondary rhinoplasty) It was used primarily as a columellar strut. Two complications with its use was seen (3%), one infection and the other exposure. Both resolved by non-surgical management.
This article brings to my mind my historic use with LactoSorb in some select rhinoplasties. LactoSorb is a well-known biodegradable polymer with a fifteen-year history of extensive use in craniomaxillofacial surgery primarily as resorbable plates and screws. I have used it in the past in rhinoplasty as well for septal support, columellar struts and spreader grafts in cleft and trauma patients. If one is careful to have good soft tissue coverage, the complication rate will be very low and one can avoid the need for cartilage harvesting. Since I am very comfortable with cartilage harvesting from all donor sites, I have not really used it in the purely aesthetic rhinoplasty patient. But this article has given me the impetus to press forward with its use more in aesthetic rhinoplasty. It would be particularly helpful as a spreader graft and columellar strut, both areas where one should almost always get cartilage and good soft tissue coverage. While complications rates for any material will never be as low as autogenous cartilage (which is essentially zero), an acceptable rate of 1 – 3% may be a good trade-off for potential donor site concerns.
Dr. Barry Eppley