Multilayer costal grafts to prevent cartilage deformation: an experimental study

Giovanni Ravasio, Riccardo Gazzola, Giuseppe Cottone, Luciano Lanfranchi, Franz Wilhelm Baruffaldi Preis

Research output: Contribution to journalArticlepeer-review


Background: Cartilage grafting is a common procedure in nasal reconstruction or dorsal augmentation. Costal cartilage is usually preferred to conchal or septal cartilage when a larger amount of graft is required, although this cartilage type is often complicated by postoperative warping. To overcome this complication, we suggest the use of multilayer costal grafts. This study aims to compare single-layer and multilayer costal grafts concerning angle of warpage, cartilage viability, and architectural changes in the animal model. Methods: Twelve costal grafts were harvested from a fresh Landrace pig cadaver; six were shaped in single-layer grafts and six into a multilayer structure, both having the same thickness. These grafts were implanted in subcutaneous dorsal skin pockets of six athymic nude rats. After 8 weeks, the animals were euthanized and the grafts removed. Pictures of the cartilages were acquired. The samples were processed and stained for histological (hematoxylin and eosin, Alcian blue, Von Kossa, Masson-Goldner trichrome, and Verhoeff/Van Gieson stains) and immunohistochemical (GFAP) analyses. Results: A higher grade of deformation was observed in the single-layer group compared to the multilayer one (5.2° vs 0.3°). Multilayer cartilage showed significantly higher chondrocyte density (70.4 vs 44.9 cells per field at 40×) and the lowest loss of nuclei in chondrocyte lacunae percentage (0.03 vs 3.2 %). Single-layer grafts also showed sporadic inflammatory cell infiltration, not found in multilayer ones. Conclusions: Multilayer grafts showed a decreased degree of warping as well as an increased viability and should be considered as a valuable alternative in nasal reconstruction. Level of evidence: Not ratable

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalEuropean Journal of Plastic Surgery
Publication statusAccepted/In press - Jul 30 2016


  • Cartilage
  • Costal graft
  • Dorsal nasal augmentation
  • Multilayer
  • Warping

ASJC Scopus subject areas

  • Surgery


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