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Surgical Technique |

Laminated Dorsal Beam Graft to Eliminate Postoperative Twisting Complications

Pieter F. Swanepoel, MD; Robert Fysh
Arch Facial Plast Surg. 2007;9(4):285-289. doi:10.1001/archfaci.9.4.285.
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Preshaped laminated dorsal beam grafts, cut and shaped, from lyophilized rib cartilage eliminate postoperative complications in the correction of saddle depression procedures; lyophilized rib cartilage does not undergo irradiation. Rhinoplasty surgeons traditionally use monounit rib cartilage to correct saddle depressions. During the 3- to 6- month postoperative recovery period, monounit grafts tend to twist and bend, often undermining the shape of the nose. Secondary or revision surgery entails removal of the monounit cartilage. Grafting material used in laminated form is more resilient and flexible than a single unit of similar material. Two-millimeter-thick rib cartilage strips counteract the distorting tendencies of monounit cartilage most effectively. After estimating the dimensions of the required lamination with soft-solid silicone sizers, rib cartilage strips are shaped and sutured into a lamination and then inserted under the skin–soft tissue envelope into the dorsal depression. Surgery is concluded in the normal manner by closing the transcolumella-incision with 6-0 fast absorbing plain cat gut sutures. Results over 3 years (117 dorsal beam procedures from 2003-2005) documented with medical case history follow-ups and postoperative imagery show that the laminations do not bend or revert to the original shape of the rib. Results 4 years after the introduction of the technique suggest that laminations counter the inherent postoperative distortion tendencies of monounit rib cartilage.

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Figure 1.

A, Two-millimeter strips of precut rib cartilage; B, soft solid silicone sizers layered in various size and length combinations.

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Figure 2.

A, Trim the cartilage into shape with a No. 15 blade scalpel; B, each cartilage strip conforms to a corresponding sizer; C, place the cartilage strips in layers, on top of each other; D, suture into position with 4-0 monofilament polypropylene (Deklene; Genzyme Corp, Cambridge, Massachusetts); E, bevel the edges of the top lamination, to prevent the edges of the graft from curling or deforming; F, slide the lamination under the skin–soft tissue envelope, placing the knot away from overlying skin; G, compare the tentative result against the patient's preoperative preview photograph.

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Figure 3.

Preoperative (A, C, E, G, and I) and postoperative (B, D, F, H, and J) results of the laminated dorsal beam graft procedure.

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Figure 4.

Sutured 2-mm-thick laminated strips of donor rib cartilage counteract the natural tendency of monounits to bend and twist.

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