Cartilage grafts : versatile

1. CARTILAGE GRAFTS
Dr.zahidah Akhter(MAMC)

2.  DEFINITION
Cartilage is a connective tissue composed of cells (chondrocytes) and fibres (collagen or
yellow elastic) embedded in a firm, gel-like matrix which is rich in a muco -polysaccharide.

3. GENERAL FEATURES:
• Cartilage has no blood vessels or lymphatics. The nutrition of cells diffuses through the
matrix.
• Cartilage has no nerves. It is, therefore, insensitive.
• Cartilage is surrounded by a fibrous membrane, called perichondrium . The articular
cartilage has no perichondrium, so that its regeneration after injury is inadequate.
• Fibrosis :low metabolic rate due to the sparsity of its cell population and its avascular
structure.
• Lack of blood supply- healing very slow , little reparative ability.

4. • The glycolytic activity and oxygen consumption of cartilage approaches anaerobic
condition and the tissue is nourished by tissue fluid diffusion . This unique non dependence
on blood supply ensures:
o That cartilage grafts will survive by imbibing surrounding fluids
o More reliable in terms of what is called as a ‘take.
o Immunologically privileged
o Allogeneic cartilage may serve as a potential graft. Autologous cartilage grafting remains
the most applicable cartilage graft.

5. CLASSIFICATION
 On the basis of relative proportions of matrix components i.e
Collagen
Elastin
Ground substance
Cartilage can be classified as:
-Hyaline cartilage ; most common type
-Fibrocartilage
-Elastic cartilage

6. HYALINE CARTILAGE FIBROCARTILAGE ELASTIC CARTILAGE
Location Articular joints of long
bones of sternum ,ribs ,
nasal ,hyaline and
laryngeal cartilages
In the intervertebral disc
of pubic symphysis ,
meniscus
temporomandibular
joints , sternoclavicular
joint
(Areas of frequent
stress)
In the pinna, external
auditory-meatus,
eustachian-tubes,
epiglottis,vocal process
of arytenoid cartilage
Colour Bluish white Glistening white Yellowish
Appearance Shiny or translucent Opaque Opaque
Elasticity Flexible More firm , high tensile
strength
Most flexible , extremely
high elasticity,
withstands repeated
bending
BD Chaurasias general anatomy

7. BD Chaurasias general anatomy

8. CARTILAGE GRAFTS CLASSIFICATION
 By matrix characteristics
Hyaline cartilage
Elastic cartilage
Fibrocartilage
 By source
Autografts
Allografts
Xenografts
 Free graft
 Microvascular composite graft.

9. AUTOGRAFTS
• Gold standard
• Nose, ear, craniofacial reconstruction
• Donor site- ear conchal bowl, nasal septum, costal cartilage
• Growth, deep layer of perichondrial connective tissue
• Inclusion of perichondrium necessary

10. ALLOGRAFTS
• Generally unsuccessful
• Matrix non-immunogenic
• Protects chondrocytes
• Once matrix breaks down, chondrocytes exposed
• Rejection
• Slow and steady resorption of cartilage allografts

11. XENOGRAFTS
• Immunogenic even after processing
• Unsuitable for human implantation

12. AURICULAR CARTILAGE GRAFT
• As an elastic cartilage, auricular cartilage is an ideal graft for transplantation
• Most versatile of all cartilage grafts
• it can be easily fashioned and contoured into different shapes for various uses.

13. • Used as a framework for ear reconstruction or auricular deformity correction.
• Conchal cartilage single-layered graft for nasal, tarsal, and nipple reconstruction.
• Can be transferred as a composite chondrocutaneous graft for nasal reconstruction.
• A significant portion of the concha can be removed without causing donor site deformity
• Harvested easily under local anesthesia

14. Nelligan volume 1

15. Nelligan volume 1

16. NASAL CARTILAGE GRAFT
• Limited in its available amount
• Employed as a composite chondromucosal graft for eyelid reconstruction.
• Septal cartilage is an important source of nasal cartilage graft.
• The septal cartilage can be accessed via a hemitransfixion incision with dissection around
the caudal margin of the quadrangular cartilage.
• After both sides of mucoperichondrium are raised, the septal cartilage can be harvested.
• Septal cartilage graft has been used for dorsal augmentation, tracheal repair, and
extended septal graft for controlling the projection and shape of nose tip.

17. • Other region available for harvesting nasal chondromucosal graft is the upper lateral
nasal cartilage
• Alar batten grafts are thin, oval shaped cartilage grafts that are placed along the nasal
sidewall in the area of the supra-alar crease or area of lateral wall weakness.
• A spreader graft is a cartilage graft that is insert between the septum and upper lateral
cartilage
• Thereby widening the area of narrowing and opening up the internal nasal valve. The
cartilage is usually carved from septal cartilage that is removed during a concurrent
septoplasty .

18. Nelligan volume 1

19. RIB CARTILAGE GRAFT
 Costal cartilage - best donor site for cartilage graft in terms of available tissue amount and
mechanical strength..
 The autologous rib cartilage can be virtually contoured into any desired shape and
 It can retain form and bulk after implantation if basic surgical principles are followed.
 The costal cartilage graft is often used as a cartilage framework for total ear
reconstruction.

20. Nelligan volume 1

21. Nelligan volume

22. Nelligan volume 1

23. Nelligan volume 1

24. Cartilage graft healing
 Transplanted autogenous cartilage graft initially depends on vascularity of recipient bed.
 Chondrocytes in cartilage graft are live and there by leading apposition growth
 Allogenic grafts: resorption
 Fibrosis

25. WARPING
• Tendency to deform under mechanical stress over several days
 Gillies,1920-
Noted that if a cartilage graft is carved so that the perichondrium remains along one side
only, the graft will curve towards that side ; he considered that the perichondrium acted like a
bowstring.
 Gibson’s principle
• States that cartilage spontaneously bends or warps away from the scored surface by
“release of interlocked stresses.”
• A number of cartilage-weakening techniques (e.g., incision, abrasion, scoring) take
advantage of this principle to recreate the anti-helical fold by interrupting the anterior
surface of the auricular cartilage .

26. DICED CARTILAGE GRAFTS
• Consists of numerous small segments of cartilage which can be packed or moulded into
desired contour.
• Used in the form of flat shavings
• Spaces between small cartilage segments are accompanied by blood initially later by
ingrowing connective tissue .
• Autogenous diced cartilage grafts contain living chondrocytes
• used in skull defects, to correct receeding chin to build out prominence of malar bone.

27. BJPS

28.  Sandwich technique :
• Eye lid reconstruction( full thickness defect)
• Auricular skin and cartilage and with intervening orbicularis muscle
 Turkish delight:
• Surgicel –wrapped diced cartilage ; used in nose surgery
• Harvested cartilage cut into pieces of 0.5 to 1mm,wrapped in one layer surgical, moistened
with antibiotic , moulded into cylindrical form and placed under nasal skin.

29.  REFERENCES
1.Nelligan; principles of plastic surgery volume 1
2.McCarthy ; general principles of plastic surgery volume 1
3.BD Chaurasia,s handbook of general anatomy
4.Cartilage grafting; By Lyndon A,Peer,M.D. BRITISH JOURNAL OF PLASTIC SURGERY