We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?


Place holder to copy figure label and caption
Figure 1.

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

Graphic Jump Location
Place holder to copy figure label and caption
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.

Graphic Jump Location
Place holder to copy figure label and caption
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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

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

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

12 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections