title: Transverse Slicing of the Sixth-Seventh Costal Cartilaginous Junction: A Novel Technique to Prevent Warping in Nasal Surgery.
abstract: BACKGROUND
  Costal cartilage is an important reconstructive tissue for correcting nasal deformities. Warping of costal cartilage, a recognized complication, can lead to significant functional and aesthetic problems. The authors present a technique to prevent warping that involves transverse slicing of the sixth-seventh costal cartilaginous junction, that when sliced perpendicular to the long axis of the rib, provides multiple long, narrow, clinically useful grafts with balanced cross-sections. The aim was to measure differences in cartilage warp between this technique (TJS) and traditional carving techniques.
  
  
  METHODS
  Costal cartilage was obtained from human subjects and cut to clinically relevant dimensions using a custom cutting jig. The sixth-seventh costal cartilaginous junction was sliced transversely leaving the outer surface intact. The adjacent sixth rib cartilage was carved concentrically and eccentrically. The samples were incubated and standardized serial photography was performed over time up to 4 weeks. Warp was quantified by measuring nonlinearity of the grafts using least-squares regression and compared between carving techniques.
  
  
  RESULTS
  TJS grafts (n = 10) resulted in significantly less warp than both eccentrically (n = 3) and concentrically carved grafts (n = 3) (P < 0.0001). Warp was significantly higher with eccentric carving compared with concentric carving (P < 0.0001). Warp increased significantly with time for both eccentric (P = 0002) and concentric (P = 0.0007) techniques while TJS warp did not (P = 0.56).
  
  
  CONCLUSIONS
  The technique of transverse slicing costal cartilage from the sixth-seventh junction minimizes warp compared with traditional carving methods providing ample grafts of adequate length and versatility for reconstructive requirements.
authors.affiliation: *Division of Plastic Surgery, Markham Stouffville Hospital, Markham †Division of Plastic Surgery, Sunnybrook Health Sciences Centre, University of Toronto ‡Department of Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Tara Lynn
authors.initials: TL
authors.lastname: Teshima
authors.forename: Homan
authors.initials: H
authors.lastname: Cheng
authors.forename: Amir
authors.initials: A
authors.lastname: Pakdel
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fialkov
mesh_terms: D064592:Autografts / Q000601:surgery / Q000637:transplantation; D066186:Costal Cartilage / Q000601:surgery / Q000637:transplantation*; D004867:Equipment Design; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D010781:Photography / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D012225:Rhinoplasty / Q000379:methods*; D046509:Tissue Culture Techniques; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods; D014584:User-Computer Interface