Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity.
BACKGROUND
Harvesting of rib as a source of cartilage can result in significant donor-site morbidity. In experienced hands, excellent results from using autologous rib cartilage are achievable for ear reconstruction, rhinoplasty, and otolaryngology. The authors report the morbidity associated with the harvest of costal cartilage in 42 patients who underwent ear reconstruction.


METHODS
The notes were examined retrospectively and further data were collected with a questionnaire. Patients noted their experience of pain, clicking, and satisfaction with the donor site. Fifteen patients underwent additional clinical assessments of their donor scar and contour deformity using a standardized scale. Five donor sites were reconstructed with spare cartilage left over from carving the ear framework.


RESULTS
The results showed that pain and clicking of the chest wall represented the commonest complaints. These peaked in the first week after surgery and diminished slowly over 3 months. The donor-site scar and deformity were acceptable to most patients. There was an improvement in the contour deformity of the chest wall harvest site in the five patients who underwent reconstruction of their donor site.


CONCLUSIONS
To improve the outcome for patients undergoing cartilage harvest, efforts must be made to further reduce pain and donor-site morbidity. Reconstruction of the donor site with spare cartilage should be attempted where possible to improve the contour defect of the donor site. Refinements in the methods of cartilage harvest or donor-site reconstruction may achieve this in the future.
Berkshire, London, and Middlesex, United Kingdom From the Department of Plastic Surgery, Heatherwood and Wexham Park Hospitals; the Department of Plastic Surgery, Royal Free Hospital; and Mount Vernon Hospital.
Rajan S
RS
Uppal
Walid
W
Sabbagh
Jagdip
J
Chana
David T
DT
Gault
D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D004431:Ear, External / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D018570:Risk Assessment; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome