title: The Effects of Mucoperichondrial Flap Elevation on Septal L-Strut Cartilage: A Biomechanical and Histologic Analysis in a Rabbit Model.
abstract: BACKGROUND
  The harvesting of septal cartilage following mucoperichondrial flap elevation has almost become a standard step in rhinoplasty. However, the strength of the remaining septum has not yet been evaluated. In the current experimental study of a rabbit rhinoplasty model, the remaining septum following a graft harvest was analyzed both biomechanically and pathologically.
  
  
  METHODS
  Forty New Zealand rabbits were classified into four equal groups. Group 1 consisted of the animals in which unilateral elevation of the mucoperichondrial flaps was undertaken before the graft harvest, group 2 consisted of the animals in which bilateral elevation was undertaken, group 3 included the animals where the septum was exposed and left untouched after a bilateral mucosal flap elevation, and group 4 was designated as the control group. Specimens were analyzed under light microscopy for multiple parameters. Biomechanical analyses were performed with a universal testing device at the Department of Engineering, Biomechanical Laboratories, Istanbul Technical University.
  
  
  RESULTS
  Biomechanical analysis in terms of maximum tension revealed significant results among the groups (p = 0.008). Although insignificant results were observed overall using a pathologic analysis, the amount of chondrocytes was lower in group 2 than in group 1 (p = 0.099). The amounts of matrix collagen (p = 0.184) and fibrosis were (p = 0.749) higher in group 2 than in group 1.
  
  
  CONCLUSIONS
  From these data, the authors conclude that mucoperichondrium integrity plays a crucial role in the biomechanical strength of the septum. More sophisticated studies with further pathologic analysis are required to determine the exact mechanism of strength loss observed with mucoperichondrial flap elevation.
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Karaca
authors.initials: K
authors.lastname: Basaran
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Salih Onur
authors.initials: SO
authors.lastname: Basat
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Asuman
authors.initials: A
authors.lastname: Ozel
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Memet
authors.initials: M
authors.lastname: Yazar
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Ergun
authors.initials: E
authors.lastname: Bozdag
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Meral
authors.initials: M
authors.lastname: Tuna
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sar
authors.affiliation: Philadelphia, Pa.; and Istanbul, Turkey.|From the Fox Chase Cancer Center; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bagcilar Training and Research Hospital; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hamidiye Sisli Etfal Training and Research Hospital; the Department of Mechanical Engineering, Istanbul Technical University; and the Pathology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Pilanci
mesh_terms: D000818:Animals; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D019736:Prostheses and Implants; D011817:Rabbits; D012225:Rhinoplasty / Q000379:methods*; D013524:Surgical Flaps