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Zheng et al. Plast Aesthet Res 2019;6:2 I http://dx.doi.org/10.20517/2347-9264.2018.76 Page 3 of 6

Table 1. A summary of study characteristics
References Processing type Complications Follow-up period mean (range)
[8]
Mühlbauer et al. , 1971 Merthiolate Absorption, 25% Mean, 6 years
(n = 40) Warping, 2.5% (range, 1 month-10 years)
Late infection, 0%
[9]
Lefkovits , 1990 Irradiation Absorption, 0% (range, 1-27 months)
(n = 24) Warping, 14.8%
Infection, 7.4%
Clark and Cook [10] , 2002 Irradiation Warping, 5.6% Mean, 26 months
(n = 18) Infection, 0%
Extrusion, 0%
[11]
Strauch and Wallach , 2003 Irradiation Extrusion, 1.5% (range, 7 months-12 years)
(n = 51) Displacement, 1.5%
Absorption, 0.8%
Fracture, 0.8%
Infection, 0%
Warping, 0%
Song et al. [14] , 2008 Tutoplast Resorption, 17% Mean, 15.6 months
(n = 35) Warping, 9% (range, 9-35 months)
Visible contour, 3%
Frature, 3%
Infection, 0%
Kridel et al. , 2009 Irradiation Warping, 1.06% Mean, 13.45 years
[12]
(n = 357) Noninfection resorption, 0.53% (range, 4 days-24 years)
Infection resorption, 0.48%
Infection, 0.87%
Mobility, 0.31%
Extrusion, 0%
[15]
Suh et al. , 2013 Tutoplast Fracture, 6.7% Mean, 29 months
(n = 30) Allowash Nasal obstruction, 3.3%
Resorption, 0%
Warping, 0%
Extrusion, 0%
Tip stiffness, 73.3%

TM
[15]
graft fracture and 1 (3%) visible graft contour [Figure 1]. Lohuis et al. used diced Tutoplast homologous
cartilage for dorsal augmentation. Their 9 patients showed no complications during the follow-up period of
20 months.
Homologous costal cartilage was mostly used for dorsal augmentation, but it can serve as a useful grafting
material for septal reconstruction. Suh et al. reported their 2-year follow-up data in 30 cases on the use of
[16]
irradiated homologous costal cartilage as a septal extension graft for the correction of the contracted nose in
Asians. There were 2 cases of graft fracture observed. Three patients underwent revision rhinoplasty, one for
nasal obstruction and 2 because of dissatisfaction with the shape of the nasal tip.

TM
Our review of these case series indicates that Tutoplast -processing methods have higher complication
[14]
[17]
rate than IHCC . This observation has already been confirmed by a systematic review by Lee et al. As
described in the literature, the use of homologous costal cartilage in rhinoplasty has yielded conflicting
results regarding the rate of resorption and warping. Although it is difficult to directly compare the surgical
outcomes of all the reports because of the differences in follow-up period and processing methods of the
cartilage, the rate of complications including resorption, warping, fracture, and infection varies greatly
between different studies. The factors responsible for increased graft resorption and warping are not clear,
but they may include the size and site of the implant, the carving technique of the graft, the nature of the
host recipient site, and thermal and mechanical damage caused during carving. The degree of warping
[18]
may also depend on the amount of radiation to which the cartilage has been exposed . Although,
[19]
Adams et al. showed that there was no significant difference in warping between irradiated and non-
irradiated homologous cartilage in vitro, it is generally believed that the radiation dose has some impact
[18]
on warping. Donald et al. postulated that the factor governing different absorption rates of IHCC from
different studies might be the radiation dose. And the study reported that high-dose irradiation appears to