I have been using irradiated donor rib cartilage for several years without major complications but patients, quite rightly, are concerned about the possibility of rejection amongst other issues.
To understand this better, my colleagues from the Royal National ENT & Eastman Dental Hospital, undertook a large retrospective study looking at our results. This was published in the journal “Facial Plastic Surgery“ in January 2025. The full study is attached here but I include a summary of the findings below:
Summary of the Study on IHCC in Nose Surgery
This study investigates the use of donor cartilage, treated with radiation, in reconstructive nose surgeries, particularly for complex cases like trauma or revision procedures. It focuses on donor rib cartilage as an alternative to autologous costal cartilage which is cartilage harvested from a patient’s own rib. While a patient’s own cartilage is effective, it has drawbacks, such as the need for a separate surgical site and risks like pain, scarring, and complications like puncturing the chest underlying lung tissue.
Why donor rib cartilage?
Donor cartilage is obtained from cadaveric donors, processed to ensure sterility, and made available “off the shelf.” It eliminates the need for an incision on the patient, thereby avoiding the risks and complications associated with a patient’s own rib. It also reduces surgery time and simplifies the procedure, making it particularly valuable in complicated or repeated surgeries where a patient’s own cartilage might no longer be available.
The Study
The research was conducted at The Royal National ENT & Eastman Dental Hospital, UCLH, in the United Kingdom, involving 57 patients between May 2022 and April 2024. These included 41 revision cases (surgeries to fix problems from earlier procedures) and 16 primary cases (first-time surgeries). Most surgeries (98.2%) were performed using an open approach, where the surgeon has better access to the nasal structure.
Donor rib grafts were prepared by soaking them in an antibiotic solution before being shaped and placed in the nose during surgery. Patients were followed up regularly for about 9 months, and outcomes were assessed based on their breathing, nasal appearance, and overall satisfaction.
Results
Complication Rates:
- Only 5.3% of patients (three cases) had mild infections after surgery, which were treated successfully with antibiotics.
- One patient (1.8%) experienced a wound issue on the nose that required another surgery
- Importantly, there were no cases of warping (bending), resorption (breaking down or disappearing), or extrusion (graft coming out of place) of the cartilage.
Success:
- Breathing improvements and satisfactory appearance were reported in all patients.
- Surgeons used donor rib cartilage for various parts of the nose, including support structures like the septum (central nasal partition) and columella (the strip of tissue between the nostrils).
Why It Matters
Patient’s own cartilage has been the gold standard for years but has certain downsides. Harvesting a patient’s own rib cartilage involves an additional surgical site (the chest), which increases the risk of pain, scarring, and chest deformities. Donor rib cartilage avoids all of these problems, while still being a reliable and durable material for reconstruction.
Additionally, using donor rib cartilage saves time during surgery, as there is no need to harvest cartilage. In many cases, use of this cartilage also allows many patients to go home the same day, even in very complex procedures that would have otherwise needed 1-2 nights in hospital with significant pain.
Key Findings
- Donor rib cartilage is a safe and effective alternative to a patient’s own rib cartilage, with low complication rates.
- It avoids the risks associated with cartilage harvesting, such as scarring or pain.
- The material is versatile, working well for both first-time surgeries and complex revisions.
- Patients reported good functional and cosmetic outcomes, with no significant long-term complications observed during the follow-up period.
