Small or large cartilage grafts to the dorsum in rhinoplasty can be done in either solid or diced (minced) form. The advantage of a diced cartilage graft is that it can not warp postoperatively and can be shaped digitally both during and immediately after surgery. When placing diced cartilage grafts in the nose it is usually necessary to place them in some sort of containment to control the location of graft placement.
Diced cartilage grafts in rhinoplasty have been wrapped in either Surgicel resorbable mesh, fascia or allogeneic dermis. Amongst surgeons there is varying opinions as to which cartilage wrap is best from a graft survival standpoint.
In the August 2016 issue of the European Journal of Plastic Surgery, an article appeared entitled ‘Survival of Minced Cartilage Grafts with Comparison Surgicel Original vs Surgicel Fibrillar’. A rabbit study was done using cartilage grafts in four groups including Group 1minced cartilage graft wrapped in Surgicel Fibrillar; Group 2 minced cartilage graft wrapped in Surgicel Original; Group 3 bare minced cartilage graft; and Group 4 bare diced cartilage graft. At three months after implantation the grafts were evaluated under light microscopy. There was no significant difference between the Surgicel Fibrillar and Surgicel Original groups with respect to inflammation, fibrosis, and basophilia. In the Surgicel Fibrillar and Surgicel Original groups, a heavy chondrocyte nucleus loss accompanied by a minimal peripheral proliferation was observed.
This limited study showed that bare minced cartilage grafts was found to be similar to that of bare diced cartilage in this study. The authors concluded that inced cartilage grafts can be used in the correction of minor dorsal defects and irregularities in persons with thin nasal skins, especially in primary and revision rhinoplasty. Although there was no histologic difference between the Surgicel Fibrillary and Surgicel Original groups, the authors think that Surgical should be used in the fibrillar form.
The Surgicel family of products (Ethicon) contains oxidized regenerated cellulose which is manufactured from a plant-based material. Whether the material is made in a mesh (Original), fluffy (Fibrillar) or particulated (Snow) form, it is made to serve as a hemostatic material. For diced cartilage grafts in rhinoplasty it merely serves as a containment method. Surgicel Fibrillar provides an easier method to wrap the small cubes of cartilage than the mesh form. Biologically there would be no reason to believe that the form of Surgicel would have any different effects on graft survival.
Dr. Barry Eppley
Indianapolis, Indiana