[Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction].
BACKGROUND
In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy.


METHODS
In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications.


CONCLUSIONS
This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.
Rasp
G
G
Klinik und Poliklinik für Hals-Nasen-Ohrenkranke, Ludwig-Maximilians-Universität München. Gerd.Rasp@hno-med.uni-muenchen.de
Staudenmaier
R
R
Ledderose
H
H
Kastenbauer
E
E
D000779:Anesthetics, Local / Q000008:administration & dosage*; D002356:Cartilage / Q000637:transplantation*; D002404:Catheterization; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control*; D012272:Ribs / Q000601:surgery*; D013525:Surgical Instruments; D014182:Transplantation, Autologous
D000779:Anesthetics, Local