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Göksel et al. Plast Aesthet Res 2019;6:17 I http://dx.doi.org/10.20517/2347-9264.2019.12 Page 7 of 8

Figure 11. Cutting harvested cartilage according to oblique split method

Numerous clinical cases have shown that a cross-sectional graft obtained through an oblique cut to the
long axis of the rib results in a graft with equal circumferential forces of contracture that have a decreased
[8]
chance of warping .

Postoperative pain
Usually the main patient’s complain after conventional rib harvesting is postoperative pain. Due to the
fact that thoracic muscles are used for such physiological process as breathing and many other everyday
activities such as getting up, speaking, walking and so forth - the thorax cannot be immobilized completely
in postoperative period. In the majority of cases these movements may cause pain conditioned by the cut
muscle fibers.

On the contrary, one of the key advantages of the endoscopic rib harvesting is reduced postoperative pain.
Significant decrease in pain is attained by means of delicate muscle undermining under endoscopic-assisted
vision, which enables to preserve the majority of muscle fibers. The use of muscle-sparing technique
contributes to faster healing with reduced postoperative pain [1.6 ± 0.9 Visual Pain Analog Scale (VAS)].
This benefit is more pronounced in the early postoperative period and is especially dramatic in reducing
[6]
movement pain .

OUR EXPERIENCE
The endoscopic-assisted rib harvesting was performed on 52 patients in last two years. In all cases no
severe complications such as pneumothorax or excessive bleeding was observed. The incision length was
1.4 ± 0.3 cm in average. Fifty patients (96%) showed no problems with scar healing and 2 patients (4%)
showed hypertrophic scar formation. Postoperative pain was evaluated by using VAS retrospectively.
Forty-eight patients (92%), who scored 1.43 ± 0.7 experienced no significant postoperative pain. Only 4
patients who scored 4.1 ± 0.8 (8%) complained of slight postoperative pain for the first 2-3 days and it was
manageable with Paracetamol 1000 mg i/v. In this cases pain was relieved with no additional painkillers or
local anesthetic agent. Dissection was done with Freer elevators, which also enabled to reduce postoperative
[6]
pain and possible intraoperative bleeding . Recovery to walk and breath normally was very short showing
1.2 ± 0.6 days. Patients did not need additional rehabilitation and recovery exercises and precautions.
With regard to our clinical study this method allows achieving reproducible, aesthetically and functionally
successful results with minimized risks.

CONCLUTION
Rib cartilage harvest is a common procedure in primary and secondary rhinoplasties. The main
disadvantages of the conventional technique for autogenous graft harvesting are risks of potential
complications such as bleeding, pneumothorax, and postoperative pain.