Section 4 Plastic and Reconstructive Problems

Reprinted by permission of Arch Facial Plast Surg. 2012; 14(6):451-455.

SURGICAL TECHNIQUE

Diced Cartilage Augmentation Early Experience With the Tasman Technique

Shan R. Baker, MD

N umerous methods have been used for dorsal augmentation in reconstructive and aes- thetic rhinoplasty. The Tasman technique is a method for dorsal augmentation using diced cartilage solidified by tissue sealant. This article describes the author’s early experience using the Tasman technique and offers some helpful suggestions to sur- geons who might wish to use this unique method of preparing a cartilaginous graft. Arch Facial Plast Surg. 2012;14(6):451-455. Published online June 18, 2012. doi: 10.1001/archfacial.2012.494

advantage of an ample supply. However, whentheribgraftiscuttosizeforprecisedor- sal augmentation, it may warp, becoming twisted and deformed. Often the grafts are too thick and result in palpable and some- timesvisibleedges, particularlywhenplaced under a thin-skinned envelope. This prob- lem led Sheen 1 to cut small strips of costal cartilage and morselize them into longitu- dinalstripsforalldorsalreconstructionsusing costal cartilage. A solid autogenous graft, whether it is septal, auricular, or costal cartilage, has the disadvantage that it must be precisely sculp- tured to create the ideal size and shape nec- essary for the ideal dorsum augmentation. A solid graft by its very nature requires a larger quantity of tissue because it is denser than if the same material is diced and used for a similar degree of dorsum augmenta- tion. This is because diced cartilage is less dense, with space interspersed between the particles of cartilage. This space eventu- ally is filled with connective tissue as the graft is successfully integrated. Diced car- tilage also has the advantage of being eas- ilymolded and shaped comparedwith solid or morselized cartilage.

Numerous methods have been used for dorsal augmentation in reconstructive and aesthetic rhinoplasty. Septal cartilage is the preferred material for dorsal augmenta- tion. Septal cartilage grafts tend not towarp or resorb and are easy to shape and fix- ate. However, septal cartilage is not al- ways of adequate amount or quality in re- vision rhinoplasty. Auricular cartilage harvested from the con- cha cavum and concha cymba can be par- tially incised along the graft’s vertical axis and folded, and the 2 segments can be su- tured together. Folding it over and sutur- ing the 2 opposing concave surfaces to- gether creates a smooth cylindrical dorsal graft measuring 3.0 cm long and 0.7 to 0.9 cm wide. This technique has the disad- vantage that it cannot be adapted to dif- fering height requirements for greater or less dorsal projection. If used as a single unfolded graft, auricular cartilage is sub- ject to warping and distortion as the soft tissue heals over it. Costal cartilage typically is the preferred dorsal graftingmaterial when there is insuf- ficient septal cartilageavailable fornecessary dorsalaugmentation.Costalcartilagehasthe REVIEW OF DORSAL GRAFTING MATERIAL

ADVANTAGES OF DICED CARTILAGE

The advantages of diced cartilage for dor- sum augmentation have led several sur- geons to advocate its use. In 1999, Erol 2

Author Affiliation: Facial Plastic and Reconstructive Surgery, University of Michigan–Center for Facial Cosmetic Surgery, Livonia.

ARCH FACIAL PLAST SURG/VOL 14 (NO. 6), NOV/DEC 2012 WWW.ARCHFACIAL.COM