title: Technical Maneuvers to Decrease Warping of Peripheral Costal Cartilage Grafts.
abstract: BACKGROUND
  Cartilage warping has plagued reconstructive and cosmetic rhinoplasty since the introduction of extraanatomical cartilage use. The authors' group theorized that, rather than focusing on the prevention of the innate tendency of rib graft warping, it may be possible to redirect the stressors toward themselves and use these forces with oppositional suturing techniques to compensate for these intrinsic characteristics.
  
  
  METHODS
  Fresh cadaver cartilage was obtained from the costosternal junction of two rib cages (aged 77 and 99 years). The cartilage was cut manually into 4 × 2.5 × 20-mm cross-sections from the cephalic edges of each of the harvested specimens. The specimens from the right chest were used as the control and the left segments underwent an oppositional suturing technique (n = 10) of the cephalic peripheral segment of the cartilage.
  
  
  RESULTS
  Overall, the control group experienced a 724.2 percent increase in the mean degree of warping (p < 0.001). In contrast, the oppositional suturing group experienced a mean decrease in warping angle relative to baseline of only 35.7 percent. At 1 month, the oppositional suturing group displayed significantly decreased warping compared with the control group.
  
  
  CONCLUSIONS
  This is a novel cadaveric study evaluating the benefit of oppositional suturing techniques in peripheral costal cartilage grafts. Multiple techniques and maneuvers have been borne out of the frustration of these inherent characteristics of costal cartilage grafts. Oppositional suturing techniques are a useful tool available to surgeons performing nasal reconstruction and revision rhinoplasty to maximize the amount of useful costal cartilage graft.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Dallas, Texas.|From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jordan P
authors.initials: JP
authors.lastname: Farkas
authors.affiliation: Dallas, Texas.|From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lee
authors.affiliation: Dallas, Texas.|From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066186:Costal Cartilage / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012225:Rhinoplasty / Q000379:methods*; D012272:Ribs / Q000601:surgery*; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome