Does a muscle-sparing rib harvesting technique reduce postoperative donor-site pain compared with a muscle-cutting technique?
In this cohort study of 19 patients, postoperative resting and movement pain scores were consistently lower in the muscle-sparing group, with significant differences between groups on several postoperative days. The postoperative need for analgesics was also reduced compared with the need in the muscle-cutting group, with a significant difference between groups on postoperative day 2.
Because the results of this study agree with anecdotal reports from influential authors, routine use of a muscle-sparing technique for rib harvesting for reducing postoperative pain at the donor site is suggested.
Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting.
To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery.
Design, Setting, and Participants
Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical.
Main Outcomes and Measures
Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used.
The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02).
Conclusions and Relevance
Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain.
Level of Evidence
Özücer B, Dinç ME, Paltura C, et al. Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty. JAMA Facial Plast Surg. 2018;20(2):136–140. doi:10.1001/jamafacial.2017.1363
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