Retrospective review of augmentation rhinoplasties using autologous cartilage grafts

The use of graft materials in rhinoplasty presents many challenges for the surgeon. There are a wide variety of alloplastic materials available for nasal augmentation but the graft material of choice remains autologous cartilage. It has considerable advantages over alloplasts. It does not induce an immune response and has a very much lower rate of infection or extrusion. It is also easily harvested and sculpted and is available in plentiful supply. We present a retrospective review of 103 patients who underwent augmentation rhinoplasty using autologous cartilage grafts with a mean follow-up time of three years six months. The revision rate over the follow-up period was 15.5 per cent (n = 16). The same surgeon’s revision rate for rhinoplasty without graft over the same period was four per cent in 311 cases. We conclude that while autologous cartilage remains the best graft material available there is a significantly higher revision rate than when no graft is required. This is primarily due to the unpredictable scarring associated with the graft in the medium term and the asymmetric nature of conchal cartilage.

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Cartilage Grafts in Dorsal Nasal Augmentation of Traumatic Saddle Nose Deformity: A Long-Term Follow-Up

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/s1535-1513(10)79619-3 ◽

2012 ◽

Vol 2012 ◽

pp. 126-127

Author(s):

K.A. Gutowski

Keyword(s):

Saddle Nose ◽

Cartilage Grafts ◽

Saddle Nose Deformity ◽

Long Term Follow Up ◽

Dorsal Nasal Augmentation ◽

Nose Deformity ◽

Nasal Augmentation

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Minimally Invasive Inlay Prosthesis Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Prospective Observational Cohort Study with Minimum 2-Year Outcomes and up to 14-Year Survival

The Journal of Knee Surgery ◽

10.1055/s-0039-3400536 ◽

2019 ◽

Author(s):

Corey Scholes ◽

Milad Ebrahimi ◽

Clarice Field ◽

Sami Farah ◽

Dennis Kerr ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Patient Reported Outcomes ◽

Revision Rate ◽

Medium Term ◽

Clinical Patient ◽

Unicompartmental Knee ◽

Patient Reported ◽

Cumulative Revision Rate ◽

Inlay Prosthesis

AbstractThere are limited medium-term outcome data available for the Repicci II device in unicompartmental knee arthroplasty (UKA). The purpose of this study was to report the medium-term (minimum 2 years) patient-reported outcomes and long-term (up to 14 years) procedure survival in a consecutive series of patients undergoing an inlay prosthesis UKA (Repicci II) at an independent orthopaedic clinic. Patients presenting with medially localized unicompartmental knee osteoarthritis and meeting the criteria appropriate for UKA were recruited to a clinical patient registry at the time of presentation. A cemented unicompartmental prosthesis (Repicci II) was implanted using minimally invasive techniques with rapid postoperative mobilization. Patients were asked to complete patient-reported outcomes preoperatively and annually postoperatively. A procedure list was cross-matched with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and an analysis of procedure survival was performed with comparison to the national data for UKA. Data from a cohort of 661 primary medial compartment UKA procedures performed in 551 patients over a 15-year period were extracted from the clinical patient registry. Significant improvements were maintained in general health, disease symptoms, pain, and function at an average follow-up of 9 years compared with preoperative data. Threshold analysis revealed that >65% of patients exceeded Patient Acceptable Symptom State at the latest follow-up, with >80% within or exceeding age-matched norms for general health. Cumulative revision rate was significantly lower than that reported for UKA in the AOANJRR at up to 13 years follow-up. This series represents a lower cumulative revision rate than previously reported, with >65% of patients reporting satisfactory functional outcomes at an average of 9 years from surgery. Surgical options for treating unicompartmental knee osteoarthritis could include UKA as a viable alternative; however, clear definitions of procedure success and its overall cost–benefit ratio in the context of ongoing management of knee osteoarthritis remain to be elucidated.

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Cartilage grafts in dorsal nasal augmentation of traumatic saddle nose deformity: A long-term follow-up

The Laryngoscope ◽

10.1002/lary.20491 ◽

2009 ◽

Vol 119 (11) ◽

pp. 2111-2117 ◽

Cited By ~ 7

Author(s):

Johnny Mao ◽

Michael Carron ◽

Senja Tomovic ◽

Kailash Narasimhan ◽

Shannon Allen ◽

...

Keyword(s):

Saddle Nose ◽

Cartilage Grafts ◽

Saddle Nose Deformity ◽

Long Term Follow Up ◽

Dorsal Nasal Augmentation ◽

Nose Deformity ◽

Nasal Augmentation

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“Ride-on” technique and other simple and logical solutions to counter most common complications of silicone implants in augmentation rhinoplasty

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.163056 ◽

2015 ◽

Vol 48 (02) ◽

pp. 172-177 ◽

Cited By ~ 3

Author(s):

Kapil S. Agrawal ◽

Manoj V. Bachhav ◽

Charudatta S. Naik ◽

Shikha Gupta ◽

Anup V. Sarda ◽

...

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Silicone Implant ◽

Silicone Implants ◽

Augmentation Rhinoplasty ◽

Alloplastic Materials ◽

Wide Range ◽

Lower Infection

ABSTRACTAugmentation rhinoplasty can be carried out using a wide range of materials including autologous bone and/or cartilage as well as alloplasts. Use of biologic bone and cartilage grafts results in lower infection rates, but they are associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in literature with extrusion, necrosis of the tip, mobility and deviation or displacement of the implant, immobile nasal tip and infection. However, they have the advantages of being readily available and easy to reshape with no requirement for harvesting autografts. Aim: To overcome these problems associated with silicone implants for which the authors have devised a novel technique, the “rideon technique”. Materials and Methods: The present study was carried out on 11 patients over a period of 4 years. The authors have devised a simple technique to fix the silicone implant and retain it in place. Restricting the implant to only dorsum avoided common complications related to the silicone implant. Results: The authors have used this technique in 11 patients with encouraging results. Follow-up ranged from 12 months to 36 months during which patients were assessed for implant mobility, implant extrusion and tip necrosis. There was no incidence of above mentioned complications in these patients. Conclusion: The “rideon technique” provides excellent stability to silicone implants and restricting the implant only to dorsum not only eliminates chances of tip necrosis and thus implant extrusion but also maintains natural shape, feel and mobility of the tip.

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Indications and Long-term Outcomes of Open Augmentation Rhinoplasty with Autogenous L-shaped Costal Cartilage Strut Grafts – A Single Plastic Surgeon’s Experience

Otolaryngologia Polska ◽

10.5604/01.3001.0011.7258 ◽

2018 ◽

Vol 72 (3) ◽

pp. 20-29 ◽

Cited By ~ 1

Author(s):

Laura Leach ◽

Eamon Shamil ◽

Charles M. Malata

Keyword(s):

Costal Cartilage ◽

Relapsing Polychondritis ◽

Patient Reported Outcome ◽

Patient Questionnaire ◽

Long Term Outcomes ◽

Augmentation Rhinoplasty ◽

Cartilage Grafts ◽

Patient Reported

Introduction We present a single surgeon’s experience of open augmentation rhinoplasty with autogenous L-shaped costal cartilage grafts, with long-term patient-reported outcome data. We highlight the salient operative steps and outline the peri-operative care required to optimise outcomes. Materials and Methods A retrospective review of eleven such augmentation rhinoplasties performed between 2008 and 2016 was undertaken. Indications included saddle nose deformity [granulomatosis with polyangiitis (n=7) and relapsing polychondritis (n=1)], post-traumatic nasal collapse (n=1) and advanced cosmetic westernisation of the nose (n=2). Long-term patient-reported outcome was assessed with a patient questionnaire. Results All patients achieved marked improvement in nasal position, shape and function. There was no cartilage exposure, warping or resorption and no recurrent deformities. One patient’s dorsal graft was fractured two years later during an ophthalmological procedure and the deformity was re-corrected successfully, again with the above technique. Average follow up was 5.2 years. Of the nine patients who responded to the follow-up questionnaire, 100% were satisfied with their nasal appearance. 100% of responders at follow-up reported that they have had no problems relating to their nose (n=9). Discussion L-shaped costal cartilage grafts provided a reliable, reproducible approach in augmentation rhinoplasty for disparate indications (inflammatory, traumatic and cosmetic) in the hands of a low-volume operator. With careful patient selection and planning, this technique can provide pleasing aesthetic outcomes and high patient satisfaction, with good long-term outcomes.

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S279 – Augmentation Rhinoplasty with Permacol and Cartilage Grafts

Otolaryngology ◽

10.1016/j.otohns.2008.05.455 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P168-P168 ◽

Cited By ~ 1

Author(s):

Thirupathirajan Thinakararajan ◽

Venkat R Srinivasan

Keyword(s):

Patient Satisfaction ◽

Senior Author ◽

Augmentation Rhinoplasty ◽

Historical Cohort ◽

Cartilage Grafts ◽

Satisfactory Outcome ◽

Long Term Follow Up ◽

The Mean

Objectives Assessment of outcome and patient satisfaction following augmentation rhinoplasty with cartilage & Permacol and safety of Permacol. Methods Permacol is a biomaterial derived from porcine dermis, modified by chemical processing. Patients with Permacol augmentation were compared with a historical cohort of patients who had cartilage augmentation. Patients, who had cartilage grafts, were retrospectively reviewed for a period of 3 years, from 2001 to 2004. Patients in the Permacol group were prospectively studied from 2003 to 2006. The senior author performed all operations. All the patients had supra-tip depression. The outcome was measured by clinical assessment, evaluation of photographs, and patient satisfaction. Results A total 24 patients had augmentation rhinoplasty-12 with cartilage and 12 with Permacol. Their age ranged from 19 to 54 years (mean 30). The mean follow-up for cartilage grafts was 33 months and for Permacol 26 months, with a minimum of 12 months for both groups. Cartilage grafts were harvested from the septum in 7 patients and from the pinna in 5 patients. All 12 patients with cartilage augmentation had satisfactory outcome. In the Permacol group, 11 out of 12 were satisfactory with the outcome. In 1 patient, Permacol graft extruded within 2 months. Conclusions Permacol graft compared very well, in terms of outcome and safety, with cartilage for augmentation of nasal dorsum. Apart from 1 case of extrusion (8%), there were no other complications. Permacol graft is readily available and easy to handle and contour. Long-term follow-up is needed for further assessment.

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Augmentation Rhinoplasty with Rib Cartilage Graft

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v30i1.383 ◽

2015 ◽

Vol 30 (1) ◽

pp. 29-33

Author(s):

Elaine Marie A. Lagura ◽

Eduardo C. Yap ◽

Anna Victoria G. Garcia

Keyword(s):

Costal Cartilage ◽

Donor Site ◽

Cartilage Graft ◽

Augmentation Rhinoplasty ◽

Cartilage Grafts ◽

Rib Cartilage ◽

Structural Support ◽

Alloplastic Materials ◽

Graft Extrusion ◽

Dorsal Nasal Augmentation

Objective: To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts Methods: Study Design: Retrospective study Setting: Tertiary Government Hospital Participants: Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012. Results: A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with 4 cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required. Conclusion: Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon’s knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity. Keywords: Rhinoplasty, rib graft, costal cartilage graft, Southeast Asian nose

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Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1716857 ◽

2020 ◽

Author(s):

Adam Lee ◽

Adam Bajinting ◽

Abby Lunneen ◽

Colleen M. Fitzpatrick ◽

Gustavo A. Villalona

Keyword(s):

Literature Review ◽

Retrospective Review ◽

Review Of The Literature ◽

Rare Presentation ◽

Spontaneous Pneumomediastinum ◽

Nonaccidental Trauma ◽

Comprehensive Literature Review ◽

Healthy Infants ◽

History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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Surgical cryoablation for the treatment of atrial fibrillation in 252 Patients. Early experience and medium-term follow-up

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-861892 ◽

2005 ◽

Vol 53 (S 01) ◽

Author(s):

N Doll ◽

T Walther ◽

V Falk ◽

H Bittner ◽

A Rastan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Early Experience ◽

Medium Term

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Ten-Year Outcome Analysis of Off-Pump Sequential Grafting: Single Surgeon, Single Center Experience

The Heart Surgery Forum ◽

10.1532/hsf98.20111087 ◽

2012 ◽

Vol 15 (3) ◽

pp. 136 ◽

Cited By ~ 2

Author(s):

Shahzad G. Raja ◽

Kareem Salhiyyah ◽

Manoraj Navaratnarajah ◽

Muhammad Umar Rafiq ◽

Jeremy Felderhof ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Medium Term ◽

Artery Bypass Grafting ◽

Off Pump ◽

Pump Coronary Artery Bypass

Objectives: Despite increasing recognition that off-pump coronary artery bypass surgery and sequential grafting strategy individually are associated with improved outcomes, concerns persist regarding the safety and efficacy of combining these 2 techniques. We compared in-hospital and midterm outcomes for off-pump multivessel sequential and conventional coronary artery bypass grafting.Methods: From September 1998 to September 2008, 689 consecutive patients received off-pump multivessel sequential coronary artery bypass grafting performed by a single surgeon. These patients were propensity matched to 689 patients who underwent off-pump coronary artery bypass grafting without sequential anastomoses. A retrospective analysis of prospectively collected perioperative data was performed. In addition, medical notes and charts of all the study patients were reviewed. The mean duration of follow-up was 5.1 � 2.0 years.Results: The major in-hospital clinical outcomes in the sequential and control groups were found to be similar. After adjusting for clinical covariates, sequential grafting was not an independent predictor of in-hospital adverse events (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.86-1.50; P = .31), medium-term mortality (hazard ratio [HR], 1.26; 95% CI, 1.06-1.32; P = .92), and readmission to hospital (HR, 1.12; 95% CI, 0.96-1.20; P = .80). Sequential grafting was an independent predictor of receiving more than 3 distal anastomoses (OR, 7.46; 95% CI, 4.27-11.45; P < .0001). Risk-adjusted survival was 89% for sequential grafting patients and 88% for conventional grafting patients (P = .96) during the medium-term follow-up.Conclusion: Our analysis confirms the short- and midterm safety and efficacy of off-pump sequential coronary artery bypass grafting.

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