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Figure 2. Rib cartilages are identified on supine position. The clavicle and xyphoid process is a key landmark and the first rib below the
clavicle is the second rib

Figure 3. While needle pricking, keeping a midline is crucial to avoid tension pneumothorax. Grabbing selected ribs with two fingers from
the other hand are helpful to guide the right direction

POSTOPERATIVE CARE
After wound closure, routine postoperative chest X-ray can be recommended until the surgeon is familiar
[1]
with the procedure . The chest wound is compressed lightly with a bandage and kept for 3 days to prevent
hematoma. Drain is unnecessary in most cases. Pain is the most common complaint after costal cartilage
harvest, regardless of purpose or extent. Many authors reported that donor site pain usually peaked in
the first week and diminished slowly over 3 months [13-19] . In the past, local application of a long-lasting
anesthetic substance close to the intercostal nerve was used to reduce extensive postoperative pain [15,16] .
[16]
Anantanarayanan et al. reported that the use of catheter-based ropivacaine provided an earlier return
to normal function with significant long duration, hence, decreasing the need for rescue analgesics.
Recently, however, other studies have proven that severe pain can be minimized with modification of rib
harvest techniques. For example, after superior and inferior perichondrium elevation, special precaution is
taken not to injure the inferior line neurovascular bundle. Rib harvesting can also be limited to the outer
lamellar while preserving the internal costal arch. By preserving the inner lamellar of the rib, postoperative
[17]
morbidities, including pain, splinting and pneumothorax, can be reduced . Recently, a muscle sparing