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Page 4 of 7 Olcott et al. Plast Aesthet Res 2019;6:3 I http://dx.doi.org/10.20517/2347-9264.2018.79

Figure 3. The average number of autologous rib harvest performed annually

Figure 4. Incision length

rib grafts. Seven (5.11%) of the respondents would consider both full and partial-thickness depending on the
circumstance. Most surgeons used an incision length between 2.1 and 4 cm (64.4%) while 2 surgeons used
< 1 cm incision [Figure 4]. The occurrence of pneumothorax after autologous rib harvest remained
low (< 1%) in most of the respondents (73.1%) while one surgeon reported 6%-10% of patients getting a
pneumothorax [Figure 5]. Regarding safety practices of the surgeons, only 24.6% (n = 33) would order a chest
X-ray routinely post-operatively while 54.5% of respondents would not. In addition, 58.7% of respondents did
not keep their patients overnight for observation after autologous rib grafting while 15.0% of them always
would. Nine surgeons would decide based on the patients (whether they are from out-of-town, have post-
operative nausea, medical comorbidities, pain and degree of rib harvested). For pain management with rib
harvest, the majority of respondents (50.4%) did not utilize any additional analgesia protocol (other than oral
pain medications). Others preferred intraoperative liposomal bupivacaine injection, indwelling catheter for
pain medication delivery, scheduled intravenous pain medications, pain management consult and intercostal
nerve block [Figure 6].