Highlight text to annotate itX
>> Dr. Lamperti: This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going
to show you how to make an Asian rhinoplasty dorsal augmentation graft using cartilage.
In this specific case we're going to be using a mix of both septal cartilage and ear cartilage
from a patient. Here I am measuring the length of each cartilage graft. This is based off
of the length of the bridge of the patient that needs to be augmented. Here I am trimming
the harvested ear cartilage from the patient that I had harvested earlier in the case.
One of the benefits of using a patient's own cartilage is that the graft can be fully customized
based off of the actual width that is needed and also the length. There is also the benefit,
of course, of using your own tissue. There is a much lower risk of rejection or infection
down the road.
Now that I have two layers of cartilage based off of the septum and ear cartilage I'll now
layer or laminate them. They are actually connected using sutures. In this case I'll
be using a mixture of both dissolvable, or resorbable, sutures and also permanent sutures.
This is mainly in areas that I want to ensure that cartilage does not want to buckle, especially
given the natural shape of the cartilage in that area. With time each layer of cartilage
will actually scar to each other. This is typically done after several months. The sutures
are mainly to ensure that there aren't any changes during the healing process. The actual
thickness of the graft is also dependent on the needs of the patient and their desires.
Some patients only need one layer of cartilage if they only need minimal augmentation whereas
other patients may need more than one, up to two or three. This patient will actually
have a three layer graft ultimately using one layer of septal cartilage and two layers
using the ear cartilage.
You may have noticed that there is actually additional septal cartilage that we could
have used. You may be wondering why I'm not using it for the bridge. The main reason is
that I'm actually performing other maneuvers during this rhinoplasty on the tip of the
nose in which I require the strong, straight cartilage of the septum. Ear cartilage isn't
typically as strong as septal cartilage and has a natural curvature of the conchal bowl.
This can be used on the dorsum regardless. You can now see the graft coming together,
looking nice and straight. Once we're done suturing the layers together we'll then be
able to bevel and trim the edges so that there are no sharp edges. This is what we're doing
now with our scalpel. As you can imagine the top of the bridge typically has a gentle curve
rather than a sharp edge. We want to make sure this is continued with the graft. Now
that we have made the graft and it is fully in place we'll now insert it in the bridge
pocket to make sure that it gives us the precise level of augmentation that we desire.