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Conchal Cartilage Harvest: Donor Site Morbidities, Patient Satisfaction, and Cosmetic Outcomes

2007; American Medical Association; Volume: 9; Issue: 4 Linguagem: Inglês

10.1001/archfaci.9.4.298

1538-3660

Steven T. Wright, Karen H. Calhoun, Michael E. Decherd, Francis B. Quinn,

Cleft Lip and Palate Research

Archives of Facial Plastic SurgeryVol. 9, No. 4 Editor's Correspondence: Research LetterFree AccessConchal Cartilage Harvest: Donor Site Morbidities, Patient Satisfaction, and Cosmetic OutcomesSteven T. Wright, Karen H. Calhoun, Michael Decherd, and Francis B. QuinnSteven T. WrightSearch for more papers by this author, Karen H. CalhounCorrespondence: Dr Calhoun, Department of Otolaryngology, University of Missouri, One Hospital Drive, Columbia, MO 65203 E-mail Address: calhounk@health.missouri.eduSearch for more papers by this author, Michael DecherdSearch for more papers by this author, and Francis B. QuinnSearch for more papers by this authorPublished Online:1 Jul 2007https://doi.org/10.1001/archfaci.9.4.298AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Conchal cartilage harvest is a widely accepted method of obtaining autologous cartilage. It has been successfully used in aesthetic and reconstructive rhinoplasty, chin augmentation, orbital floor reconstruction, and ear reconstruction.1-6 Many articles have analyzed the recipient sites of conchal cartilage grafts, mainly in the area of aesthetic rhinoplasty. There is a paucity of information in the literature regarding donor site morbidity as well as on patient satisfaction and cosmetic outcome of conchal cartilage harvest. Previous articles7,8 that have attempted to classify the donor site morbidity associated with conchal cartilage harvest have been limited. There is very little information in the literature about patient satisfaction and cosmetic outcomes associated with conchal cartilage harvest.9MethodsA 3-part study was undertaken to evaluate the donor site morbidity, perioperative and long-term patient satisfaction, and cosmetic outcomes of conchal cartilage harvest. In the first part, a retrospective review of the medical charts of 76 patients treated by anterior approach conchal cartilage harvested over a 9-year period was performed. In the second part, perioperative and postoperative patient satisfaction was evaluated using a telephone questionnaire. In the third part, the cosmetic outcome was evaluated by blinded reviewers who examined patient photographs. Once the actual operated ear was identified to the reviewers, the cosmetic impact of the incision was evaluated with a visual analog scale.After standard sterile procedures, subcutaneous injections of lidocaine, 1%, with epinephrine, 1:100 000, were used along the conchal bowl. A No. 15 scalpel blade or Beaver blade was used to create an incision just inside the helical bowl, leaving a 2- to 3-mm margin of outer rim of the conchal bowl. This incision was carried down through the perichondrial layer. The anterior perichondrium was then sharply dissected from the conchal cartilage until an adequate amount of cartilage was exposed. The maximal amount of cartilage was then harvested with the posterior perichondrium intact. The incision was closed using a running 6-0 fast-absorbing gut suture. Two dental rolls were secured with polypropylene mesh (2-0 Prolene; Ethicon, Cornelia, Georgia) to ensure reapproximation of the perichondrial flap. The dental rolls were removed on postoperative days 5 to 7. The patients were instructed to avoid sleeping on the operated ear.ResultsRetrospective review revealed 92 conchal cartilage harvest operations performed from 1994 to 2003. Mohs micrographic surgery was the most common procedure (68 procedures [74%]) associated with conchal cartilage harvest. Revision rhinoplasty (19 procedures [21%]) and other procedures (5 [5%]) including orbital wall reconstruction were less common. The mean age of the patients was 56 years; 71 (94%) of the patients were white, and 5 (7%) were Hispanic. Men underwent conchal cartilage harvest more often than women (56% vs 44%). The left side was harvested more often than the right (58% vs 38%) because right-handed people tend to use the telephone at their right ears. Harvest was bilateral in 4 cases. The mean duration of follow-up for clinical evaluation was 11.8 months. Of the 76 subjects, 60 (80%) received preoperative or intraoperative antibiotics, and 100% received postoperative oral antibiotics for a length of 7 days. The most commonly used antibiotic regimen was cefazolin and cephalexin. Clindamycin or levofloxacin was used most commonly in patients who were allergic to penicillin. Significant tobacco usage was found in 21 (28%) of the patients. Twelve (16%) reported alcohol usage in excess of 12 drinks per week. Thirty-nine (51%) had associated comorbidities, including cardiovascular problems requiring aspirin or blood thinners, and 4 (5%) were receiving medications for diabetes mellitus.Regardless of age, sex, comorbidities, and alcohol or tobacco use, patients reported no complications in the operated ear as a result of conchal cartilage harvest.Patient satisfaction with the operated ear was evaluated with a telephone questionnaire of 50 patients for whom medical chart review had been completed and who had undergone conchal cartilage harvest. Only 2 of the 50 patients polled reported any concerns around the time of surgery (4%). These 2 perioperative complaints were of mild pain. For these patients, the mean duration of follow-up was 16 months. None of the patients polled reported any current problems with the operated ear. Forty-six patients rated their satisfaction as 10 on a 10-point scale. One patient rated it as 9 of 10, and 3 rated it as 8 of 10. None of the 50 patients contacted felt as if they or anyone around them could even notice the incision in their ear.After obtaining informed consent, 16 patients participating in a session of standardized digital photography that included right and left lateral views taken at 24 inches, as well as anterior and posterior views of the head. These pictures were printed in an 8 × 10-inch color format. Ten naïve reviewers (nonmedical personnel) were then blinded as to which ear had undergone conchal cartilage harvest. Each reviewer was then presented with the standardized photographs. In 34% of the cases, the reviewers felt that they could not confidently tell the difference between the operated and nonoperated ears and could not make a decision. Of the remaining 66% of the cases, for which responses were made, the blinded reviewers incorrectly chose the operated ear in 58% of the responses. The reviewers were then educated as to which was the correct ear in each case. An anatomically labeled drawing of the pinna with a marked line indicating the proposed incision within the conchal rim was then shown to the reviewers. A 10-point visual analog scale was then completed by each reviewer for each case to evaluate the cosmetic spectrum of the impact of the incision from disfiguring (1) to imperceptible (10). The reviewers felt that the incision obtained 94% imperceptibility.CommentConchal cartilage is widely accepted for use during revision and reconstructive rhinoplasty, orbital wall reconstruction, and eyelid repair. The anterior approach to conchal cartilage harvest has become the most popular technique. After observing successful changes in the ear for anterior conchal cartilage harvest, some authors10,11 have even developed new techniques for anterior approach otoplasty. Modest complication rates have been reported for both the anterior and posterior approaches, and complications including hypertrophic scarring, delayed wound healing, and asymmetry. Our patients underwent anterior approach only by a standardized method. Feared complications of any cosmetic surgery include hypertrophic scarring, postoperative hematomas or seromas, and infections. Fortunately, in our series of patients, there were no complications in the ears in which conchal cartilage was harvested, regardless of comorbidities, including tobacco and alcohol use, cardiovascular conditions, or diabetes mellitus. Use of perioperative antibiotics for cosmetic procedures is widely accepted and should be used in patients that are undergoing conchal cartilage harvest.Most of the patients underwent conchal cartilage harvest for Mohs micrographic surgical repair of facial malignancies. The morbidities of rhinoplasty, locoregional flaps, and tissue advancements, as well as staged procedures for repair of the nasal defects, would tend to distract the patient's attention from the less morbid conchal harvest. This, combined with the average duration of follow-up from surgery to telephone questionnaire, may have allowed some recall bias. Regardless, the rate of patient satisfaction with conchal cartilage harvest was very high. The only concerns reported were those of mild pain in the immediate postoperative period. There were no complaints of irritating dental roll bolsters, hearing changes, or problems that affected sleep positions.Most of the responses by the blinded reviewers who felt that they could make a distinction between the operated and nonoperated ear were incorrect. This may reflect the relative lack of knowledge by nonmedical personnel regarding the complex 3-dimensional auricular anatomies. After the reviewers were educated about basic auricular anatomy and conchal cartilage harvest, they felt that the incision was 94% imperceptible.Septal cartilage has proved to be the type most commonly used for autologous cartilage harvest and will likely remain that way owing to the robust nature of that type of cartilage and the indication for septoplasty associated with rhinoplasty. When septal cartilage is not available, however, conchal cartilage is a safe and cosmetically acceptable alternative for autologous cartilage harvest. Patients are very satisfied with conchal cartilage harvest.References1. Collawn SS, Fix R, Moore J, Vasconez L. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg. 1997;100 6 1547-1552 9385970 Crossref, Medline, Google Scholar2. Jovanovic S, Berghaus A. Autogenous auricular concha cartilage transplant in corrective rhinoplasty: practical hints and critical remarks. Rhinology. 1991;29 4 273-280 1780628 Medline, Google Scholar3. Juri J, Juri C, Elias J. Ear cartilage grafts to the nose. Plast Reconstr Surg. 1979;63 3 377-381 419217 Crossref, Medline, Google Scholar4. Neu B. Combined conchal cartilage-ethmoid bone grafts in nasal surgery. Plast Reconstr Surg. 2000;106 1 171-175 Crossref, Medline, Google Scholar5. Neu BR. Segmental bone and cartilage reconstruction of major nasal dorsal defects. Plast Reconstr Surg. 2000;106 1 160-170 10883630 Crossref, Medline, Google Scholar6. Viterbo F. Chin augmentation with conchal cartilage. Plast Reconstr Surg. 2003;111 2 899-903 12560719 Crossref, Medline, Google Scholar7. Grobbelaar AO, Matti B, Nicolle F. Donor site morbidity post-conchal cartilage grafting. Aesthetic Plast Surg. 1997;21 2 90-92 9143422 Crossref, Medline, Google Scholar8. Nicolle F, Grobbelaar A. Technique for harvesting conchal cartilage grafts. Aesthetic Plast Surg. 1997;21 4 243-244 9263545 Crossref, Medline, Google Scholar9. Akcam T, Friedman O, Cook TA. The effect of snoring on structural nasal valve dilatation with a butterfly graft. Arch Otolaryngol Head Neck Surg. 2004;130 11 1313-1318 15545588 Crossref, Medline, Google Scholar10. Stucker FJ, Vora N, Lian T. Otoplasty: an analysis of technique over a 33-year period. Laryngoscope. 2003;113 6 952-956 12782804 Crossref, Medline, Google Scholar11. Erol OO. New modification in otoplasty: anterior approach. Plast Reconstr Surg. 2001;107 1 193-202 11176623 Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited byDonor site morbidities resulting from conchal cartilage harvesting in rhinoplasty20 March 2017 | The Journal of Laryngology & Otology, Vol. 131, No. 6Multilayer costal grafts to prevent cartilage deformation: an experimental study30 July 2016 | European Journal of Plastic Surgery, Vol. 39, No. 6Simultaneous retraction and marking for maximum conchal cartilage harvest4 February 2013 | The Laryngoscope, Vol. 123, No. 7BibliographyRhinoplastyAging Male RhinoplastyFacial Plastic Surgery Clinics of North America, Vol. 16, No. 3Current World LiteratureCurrent Opinion in Otolaryngology & Head & Neck Surgery, Vol. 16, No. 4 Volume 9Issue 4Jul 2007 InformationCopyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Steven T. Wright, Karen H. Calhoun, Michael Decherd, and Francis B. Quinn.Conchal Cartilage Harvest: Donor Site Morbidities, Patient Satisfaction, and Cosmetic Outcomes.Archives of Facial Plastic Surgery.Jul 2007.298-299.http://doi.org/10.1001/archfaci.9.4.298Published in Volume: 9 Issue 4: July 1, 2007PDF download