Abstract
Background: When there is insufficient septal cartilage graft for nasal reconstruction, current alternatives include the autologous costal cartilage (ACC) graft, irradiated homologous costal cartilage (IHCC) graft, and synthetic (alloplastic) polymer scaffolds. Newer alternatives such as hybrid bioactive-biocompatible polymer scaffolds and tissue-engineered cartilage grafts have also emerged. With the widespread use of alternative grafts in septorhinoplasty, multiple systematic reviews have analyzed their complication rates with varying results. This systematic review aims to summarize the current body of systematic reviews analyzing complication rates for ACC, IHCC, and alloplastic grafts in septorhinoplasty. In addition, it aims to provide an overview of the recent progress of newer grafts and potential avenues for future research.
Methods: A comprehensive search of EMBASE, Medline, Google Scholar and Evidence-Based Medicine Reviews (EMBR) was conducted for systematic reviews with more than 10 primary studies analyzing complication rates of ACC, IHCC, and alloplastic grafts in septorhinoplasty. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Risk of Bias in Systematic Reviews (ROBIS) tool was used. Outcomes for qualitative evaluation included overall complication rate, infection, warping, resorption, extrusion, hypertrophic scarring, pneumothorax, and revision and implant removal surgery.
Results: Six systematic reviews were included that analyzed ACC with alloplastic grafts (n=2), ACC with IHCC grafts (n=1), alloplastic grafts only (n=2), and ACC grafts only (n=1). ACC grafts were associated with warping, resorption, revision surgery and donor-site morbidity. IHCC grafts had similar complication rates to ACC grafts in specific situations. Infection, extrusion, and removal surgery rates were generally higher amongst all alloplastic grafts, although rates varied between specific alloplastics. The Corrected Covered Area (CCA) was calculated as 10.63% limiting direct comparison of results between reviews.
Conclusions: Whilst it is evident that biologic and alloplastic grafts do not fulfil the criteria of the ideal graft described in the literature, newer alternatives such as tissue-engineered grafts and bioactive-biocompatible polymer composites still require more research to characterize their complication rates.
Methods: A comprehensive search of EMBASE, Medline, Google Scholar and Evidence-Based Medicine Reviews (EMBR) was conducted for systematic reviews with more than 10 primary studies analyzing complication rates of ACC, IHCC, and alloplastic grafts in septorhinoplasty. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Risk of Bias in Systematic Reviews (ROBIS) tool was used. Outcomes for qualitative evaluation included overall complication rate, infection, warping, resorption, extrusion, hypertrophic scarring, pneumothorax, and revision and implant removal surgery.
Results: Six systematic reviews were included that analyzed ACC with alloplastic grafts (n=2), ACC with IHCC grafts (n=1), alloplastic grafts only (n=2), and ACC grafts only (n=1). ACC grafts were associated with warping, resorption, revision surgery and donor-site morbidity. IHCC grafts had similar complication rates to ACC grafts in specific situations. Infection, extrusion, and removal surgery rates were generally higher amongst all alloplastic grafts, although rates varied between specific alloplastics. The Corrected Covered Area (CCA) was calculated as 10.63% limiting direct comparison of results between reviews.
Conclusions: Whilst it is evident that biologic and alloplastic grafts do not fulfil the criteria of the ideal graft described in the literature, newer alternatives such as tissue-engineered grafts and bioactive-biocompatible polymer composites still require more research to characterize their complication rates.
| Original language | English |
|---|---|
| Article number | 28 |
| Pages (from-to) | 1-12 |
| Number of pages | 12 |
| Journal | Australian Journal of Otolaryngology |
| Volume | 5 |
| DOIs | |
| Publication status | Published - Nov 2022 |
| Externally published | Yes |
Bibliographical note
Copyright the Publisher. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.Keywords
- Rhinoplasty
- autologous costal cartilage (ACC)
- alloplastic
- tissue engineering
- biosynthetic