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Page 4 of 6 Zheng et al. Plast Aesthet Res 2019;6:2 I http://dx.doi.org/10.20517/2347-9264.2018.76

Figure 1. Surgical outcome of rhinoplasty using Tutoplast-processed costal cartilage

lessen greatly the stiffness of cartilage grafts and may be responsible for increasing absorption of the graft.
Not only the tissue processing method, but also a consistent and meticulous way of tissue handling may be
[20]
an important factor in reducing complication rates. Kridel and Sturm recommended that sterile handling,
followed by a rinse with saline and antibiotics, removal of perichondrium, waiting 20 min after carving to
allow time for initial warping, and the use of perioperative antibiotics are important elements to reduce
complications.

[16]
The fate of implanted homologous cartilage has been studied. Suh et al. took biopsies of the irradiated
cartilage grafts at 18 months and 5 years postoperatively from the study group were compared with
preoperative IHCC samples and normal rib cartilage from other patients. They noted that the normal rib
cartilage showed intact chondrocytes with extensive HLA-B expression, whereas the preoperative IHCC
samples showed no visible normal chondrocytes despite well-maintained lacunar structures, and with much
less HLA-B antigen expression. They also found the formation of the thin capsule-like tissue surrounding
the IHCC.

It is noteworthy to mention that other than the commonly noted complications of homologous costal
cartilage, the possibility of transmission of unknown viral or prion disease which is difficult to screen can
be a potential concern when we consider the use of homologous costal cartilage in rhinoplasty. However,
studies are lacking on this subject. Freeze drying is a different method of tissue processing, but there is a
paucity of studies showing the performance of homologous costal cartilage processed with this particular
technique.

CONCLUSION
Previous reports frequently indicate that homologous cartilage is often more easily absorbed than autologous
cartilage, and the senior author has had a similar experience. Furthermore, since cartilage differs in physical
characteristics based on tissue processing methods and the cadavers from which the cartilage is harvested
are of different age groups, it is hard to expect a consistent quality of cartilage from this implant. The
TM
[14]
authors have abundant experience in rhinoplasty using Tutoplast processed costal cartilage . According
to the author’s experience, this cartilage is generally useful for septal reconstruction or tip surgery. However,
when used for the nasal dorsum, complications such as resorption, fracture, and deformation are somewhat
frequent. Therefore, we came to the conclusion that it is not the optimal material to be used for dorsal
grafting. However, this graft is still a useful alternative for patients that require ample graft material, where