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Surgical Pearls
Jul/Aug 2017

Technique to Reduce Time, Pain, and Risk in Costal Cartilage Harvest

Author Affiliations
  • 1Department of Otolaryngology, Naval Medical Center, San Diego, California
JAMA Facial Plast Surg. 2017;19(4):333-334. doi:10.1001/jamafacial.2016.2144

Costal cartilage’s utility for reconstructing the nasal framework has been well documented and accepted since the turn of the 20th century, when Sir Harold Gillies began using this autograft in the reconstruction of wounds sustained on the battlefields of World War I.1 The complications associated with harvesting and using rib grafts are also well documented, and techniques have evolved with goals of reducing donor site morbidity and graft warping. The most common complaint after costal cartilage harvest is pain, regardless of purpose or extent of harvest.2 While pain may result in respiratory splinting, atelectasis, and possibly pneumonia, pneumothorax is the donor-site complication that the surgeon is most wary of intraoperatively and postoperatively. We describe a novel costal cartilage harvest technique that mitigates the risk of an inadvertent pleural tear, may be quicker, and, in conjunction with a long-acting local anesthetic, seems to reduce postoperative donor-site pain with its inherent risk for respiratory splinting and pneumonia.

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