Costal Cartilage Autograft Harvest: Inferior Strip Preservation Technique
Bibliographic record
Abstract
Sir: Von Mangoldt first described using costal cartilage as grafting material for nasal reconstruction in 1889.1 Costal cartilage is ideal when a significant degree of augmentation is needed for volume filling and reconstructing nasal skeletal architecture. Indications include saddle nose deformity, congenital nasal deformity, significant underprojection, non-Caucasian race, and revision rhinoplasty.2 Disadvantages include donor-site morbidity, increased operative time, and graft warping. Pneumothorax is a serious but avoidable complication with careful elevation of the perichondrium on the rib undersurface. Pain control is the chief disadvantage for patients, and is most apparent during sudden movements, stretching, and when sitting up.3 Our novel modification of harvest technique, preservation of an inferior cartilaginous strip, minimizes pain, the most clinically significant drawback (Fig. 1).Fig. 1.: Schematic representation of the inferior strip preservation technique for harvest of autologous costal cartilage. The outlined area represents the portion from the superior aspect of costal cartilage to be sharply excised. The red outline represents the costal cartilaginous-sternal junction.A 3- to 5-cm inframammary incision overlying the sixth rib is made. Subcutaneous and fascial layers are dissected with electrocautery to the external oblique muscles, which are incised over the identified costal arch. The overlying perichondrium is incised longitudinally along the rib axis. Meticulous subperichondrial elevation is performed anteriorly and posteriorly (Fig. 2). The desired segment of cartilage is excised with a no. 20 blade, with an elevator on the rib undersurface protecting the thoracic cavity. In standard harvesting techniques, a full segmental piece from the osteocartilaginous junction to its junction with the sternum is removed. We preserve an inferior cartilaginous strip in continuity from bony junction to sternum.4 Subsequently, the perichondrium is inspected to ensure that continuity, hemostasis, and layered closure are performed.Fig. 2.: (Above) Intraoperative image depicting the portion of costal cartilage to be excised (outlined), whereas the strip of cartilage inferior to the demarcated region will be preserved. (Below) Subsequent to excision, a strip of cartilage is preserved inferior to the graft harvest site in full continuity from the bony junction to the sternum.Facial plastic surgeons often face complex nasal defects necessitating costal cartilage grafting. Donor-site pain is the chief drawback of costal cartilage harvest. Our modification of standard rib autografting techniques minimizes morbidity by preserving rib arch continuity, minimizing mobility. This technique provides abundant grafting material and has successfully been used by the senior author in over 70 consecutive cases. DISCLOSURE None of the authors has any commercial associations or financial disclosures that may pose or create a conflict of interest. Nitin Chauhan, M.D. Ali Sepehr, M.D. Andres Gantous, M.D. University of Toronto Department of Otolaryngology–Head and Neck Surgery Division of Facial Plastic and Reconstructive Surgery Saint Joseph's Health Center Saint Michael's Hospital Toronto, Ontario, Canada
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".