Specific allograft processing methods may contribute to high failure rates.
Objectives:
To characterize commonly used proprietary costal cartilage allograft processing techniques among tissue banks and assess surgeon preferences for graft sterilization methods in rhinoplasty.
Methods:
A comprehensive review of American Association of Tissue Banks (AATB)-certified cartilage providers was performed using public databases, United States Patent and Trademark Office records, PubMed, and consultation with research scientists. An international survey of rhinoplasty surgeons in the Evidence-Based Rhinoplasty Reading Group assessed allograft preferences for rhinoplasty.
Results:
Among 41 AATB-certified cartilage providers, 12 distinct proprietary processing protocols were identified. Gamma irradiation (1.0–5.0 Mrad) was used in 63.6% of methods. Peroxide-based detergents, including hydrogen peroxide, were used in 36.4%, and alcohol-based detergents, including isopropyl alcohol, in 36.4%. Antibiotic or aseptic solutions (bacitracin, polymyxin B, gentamicin) were incorporated in 45.4% of protocols. Survey respondents favored fresh-frozen costal cartilage allograft, although most surgeons (74.6%) reported exclusive use of autologous costal cartilage.
Conclusions:
Substantial heterogeneity exists in costal cartilage allograft processing methods and surgeon selection preferences. Variability in processing may contribute to differences in reported clinical outcomes. Greater understanding of these methods may guide future research and support evidence-based graft selection.
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References
1.
ToriumiDM. Structural approach to primary rhinoplasty. Aesthet Surg J. 2002; 22(1):72–84; doi: 10.1067/maj.2002.122071
GruberRP, NahaiF, BogdanMA, et al.Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: Part II. Clinical results. Plast Reconstr Surg. 2005; 115(2):595–606; discussion 607–608; doi: 10.1097/01.prs.0000150146.04465.81
5.
HalepasS, LeeKC, CastiglioneC, et al.Grafting in modern rhinoplasty. Oral Maxillofac Surg Clin North Am. 2021; 33(1):61–69; doi: 10.1016/j.coms.2020.09.003
6.
WeeJH, ParkMH, OhS, et al.Complications associated with autologous rib cartilage use in rhinoplasty: A meta-analysis. JAMA Facial Plast Surg. 2015; 17(1):49–55; doi: 10.1001/jamafacial.2014.914
7.
LeeJS, LeeDC, HaDH, et al.Redefining the septal L-Strut to prevent collapse. PLoS One. 2016; 11(4):e0153056; doi: 10.1371/journal.pone.0153056
8.
AdamsWP, RohrichRJ, GunterJP, et al.The rate of warping in irradiated and nonirradiated homograft rib cartilage: A controlled comparison and clinical implications. Plast Reconstr Surg. 1999; 103(1):265–270; doi: 10.1097/00006534-199901000-00042
9.
ToriumiDM. Choosing autologous vs irradiated homograft rib costal cartilage for grafting in rhinoplasty. JAMA Facial Plast Surg. 2017; 19(3):188–189; doi: 10.1001/jamafacial.2017.0036
10.
SajjadianA, NaghshinehN, RubinsteinR. Current status of grafts and implants in rhinoplasty: Part II. Homologous grafts and allogenic implants. Plast Reconstr Surg. 2010; 125(3):99e–109e; doi: 10.1097/PRS.0b013e3181cb662f
11.
VaradharajanK, SethukumarP, AnwarM, et al.Complications associated with the use of autologous costal cartilage in rhinoplasty: A systematic review. Aesthet Surg J. 2015; 35(6):644–652; doi: 10.1093/asj/sju117
12.
WrightJM, HalseyJN, RottgersSA. Dorsal augmentation: A review of current graft options. Eplasty. 2023; 23:e4.
13.
DonaldPJ, Deckard-JanatpourK, SharkeyN, et al.The effects of irradiation dose on the stiffness of cartilage grafts. Ann Plast Surg. 1996; 36(3):297–303; doi: 10.1097/00000637-199603000-00012
14.
LeeJH, ChangCH, SeoSW, et al.The effects of sterilization methods on lyophilized cartilage grafts in an experimental model. J Craniofac Surg. 2013; 24(4):1436–1440; doi: 10.1097/SCS.0b013e31829025ab
15.
ZhangHR, XuMY, ZhangL, et al.Effects of chemical sterilization and gamma irradiation on the biochemical and biomechanical properties of human tendon allografts in vitro study. Orthop Surg. 2022; 14(10):2657–2668; doi: 10.1111/os.13465
16.
HaimiS, VienonenA, HirnM, et al.The effect of chemical cleansing procedures combined with peracetic acid-ethanol sterilization on biomechanical properties of cortical bone. Biologicals. 2008; 36(2):99–104; doi: 10.1016/j.biologicals.2007.06.001
LangerF, GrossAE. Immunogenicity of allograft articular cartilage. J Bone Joint Surg Am. 1974; 56(2):297–304.
30.
WeeJH, MunSJ, NaWS, et al.Autologous vs irradiated homologous costal cartilage as graft material in rhinoplasty. JAMA Facial Plast Surg. 2017; 19(3):183–188.
31.
SaadiR, LoloiJ, SchaeferE, et al.Outcomes of cadaveric allograft versus autologous cartilage graft in functional septorhinoplasty. Otolaryngol Head Neck Surg. 2019; 161(5):779–786.
32.
SinghR, SinghD, SinghA. Radiation sterilization of tissue allografts: A review. World J Radiol. 2016; 8(4):355–369.
33.
IAEA TA. Guidelines for industrial radiation sterilization of disposable medical products. IAEA-TECDOC-539 International Atomic Energy Agency. 1990.
34.
RohrichRJMD, AbrahamJMD, AlleyneBMD, et al.Fresh frozen rib cartilage grafts in revision rhinoplasty: A 9-year experience. Plast Reconstr Surg. 2022; 150(1):58–62.
35.
PrussA, BaumannB, SeiboldM, et al.Validation of the sterilization procedure of allogeneic avital bone transplants using peracetic acid-ethanol. Biologicals. 2001; 29(2):59–66.
36.
ErasV, GraffunderJ, AhmedN, et al.Influence of peracetic acid-ethanol sterilisation on the biomechanical properties of human meniscus transplants. J Exp Orthop. 2021; 8(1):18.
37.
JacksonDW, WindlerGE, SimonTM. Intraarticular reaction associated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med. 1990; 18(1):1–10.
38.
ProloDJ, PedrottiPW, WhiteDH. Ethylene oxide sterilization of bone, dura mater, and fascia lata for human transplantation. Neurosurgery. 1980; 6(5):529–539.
39.
LauBC, WongKK, PhilpottCM, et al.Cartilage on the floor: How effective is antibiotic sterilization? J Otolaryngol Head Neck Surg. 2011; 40(3):221–225.
