title: Pressure necrosis of septal cartilage associated with bilateral extended spreader grafts in rhinoplasty.
abstract: OBJECTIVE
  To investigate septal cartilage compressive changes as a result of bilateral extended spreader grafts (ESGs), which are commonly used in rhinoplasty. The buckling, rupturing, or necrosis of the recipient site leads to nasal tip structural deformity. These pathologic changes associated with bilateral ESGs warrant the clinician's attention and in-depth basic and clinical research.
  
  
  METHODS
  The basic experimental study involves New Zealand rabbits, randomly assigned to groups A, B, C, and D, with group A as a reference. The right auricular cartilage was harvested and transplanted into a corresponding anatomic location of the left ear. The compressive effect was studied by gross observation and microscopic examination with hematoxylin-eosin staining after 3 months. In a clinical experiment, revision rhinoplasty surgical procedures were performed in 10 human patients 6 months to 1 year after placement of bilateral ESGs. The compressive changes of septal cartilages between the ESGs were observed intraoperatively.
  
  
  RESULTS
  In group A of the rabbits, no pathologic change was noted, but 2 cases of attenuation were observed in group B (33.3%), 6 cases of central fracture (100%) with 1 case of perforation (16.7%) in group C, and 6 cases of different degrees of defects in group D (100%). Clinical intraoperative observations revealed 1 case of defects and necrosis (10%), 4 cases of attenuations and cracks (40%), and 5 cases of attenuations (50%).
  
  
  CONCLUSIONS
  Septal cartilage compressive necrosis leading to structural damage by bilateral septal ESGs is a clinically significant complication of rhinoplasty. Owing to its affect on the viability of the original septal cartilages, we believe the unilateral ESG with columellar strut is preferred, especially in Asian patients.
authors.affiliation: Shimmian Rhinoplasty Clinic, 211, Seocho Hyundai Tower, 1319-13, Seocho-dong, Seochu-gu, Seoul 137-070, South Korea. doctorshanlei@gmail.com
authors.forename: Dong-Hak
authors.initials: DH
authors.lastname: Jung
authors.forename: Geun-Uck
authors.initials: GU
authors.lastname: Chang
authors.forename: Lei
authors.initials: L
authors.lastname: Shan
authors.forename: Da-Lie
authors.initials: DL
authors.lastname: Liu
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Hong-Jun
authors.initials: HJ
authors.lastname: Tian
authors.forename: Can
authors.initials: C
authors.lastname: Chen
authors.forename: Wade W
authors.initials: WW
authors.lastname: Han
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D023421:Models, Animal; D009300:Nasal Septum / Q000473:pathology*; D009336:Necrosis; D011183:Postoperative Complications; D011312:Pressure; D011817:Rabbits; D011897:Random Allocation; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome