PMID: 12370656
Issn Print: 0148-7043
Publication Date: 2002/10/01
K-wire: A Simple and Safe Method for Internal Stabilization of Costal Cartilage in L-strut Grafts
Nedim Sarifakioglu; Bülent Cigsar; Gürcan Aslan
Excerpt
Cartilage is an excellent support for providing contour restoration in rhinoplasty as a dorsal onlay graft and columellar strut. The standard and the most convenient cartilage for grafting in nasal surgery is autogenous septal cartilage for mild deficiencies in projection of the tip and dorsum. Autogenous rib cartilage may be used if larger pieces of cartilage are needed, particularly to provide support, or when a sufficient quantity of septal cartilage is lacking as a result of previous septoplasty. Autogenous rib cartilage can be used for dorsal augmentation when shaped as an “L.” The angle between the limbs of the L can be formed with permanent sutures. The L-strut graft will project the tip and will maintain support both for the tip and the dorsum of the nose. Thus, the sutures must provide appropriate angulation and sufficient strength. However, it must be kept in mind that even sutures will traumatize this already delicate area and cause it to become the weakest point of the graft. To overcome this disadvantage we prefer the integration of costal cartilage grafts using an angular K-wire. This technique has several advantages. K-wire is an inexpensive material, can be obtained easily, and can be found in different lengths and thicknesses. During K-wire fixation, rigid tip projection can be achieved easily in any angle. The rigid supportive K-wire will form a barrier to the warping of the cartilage graft. Placing the K-wire limited to the corner of the L avoids extrusion of the wire. The L-strut can be shaped in a short time using this easy technique. Application consists of securing the K-wire with a clamp and advancing it carefully in the middle of the cartilage. The entire process can be finished in 30 seconds. Extreme care should be taken to keep the K-wire embedded in the middle of the cartilage while advancing it. Another advantage of this technique is that it allows clear visualization of the cartilage portion and the angulation on plain nasal radiographs.
Before fixing the K-wire, depending on the necessary angle, preparing the corner of the cartilage grafts in an oblique shape similar to a corner of a frame (with an angle of 45 deg) will allow the K-wire to lie completely in the cartilage. Keeping the length of K-wire limited to 1 to 2 cm and not advancing it completely through the cartilage will prevent extrusion of the wire. In addition, resting the dorsal portion of the graft on the nasal radix and the columellar portion on the nasal spine will help further to avoid extrusion of the wire from these areas (Fig 1).
Nasal restorations with bone and alloplastic materials have numerous disadvantages and there is a great deal of disagreement about the ideal graft choice. Disadvantages of bone grafts can be summarized as high rate of resorption; formation of a rigid, immobile nasal tip; difficulty in shaping; and donor site morbidity. However, alloplastic materials always carry a substantial risk for extrusion and infection. Rib cartilage grafts, however, have a tendency to warp if they do not contain a rigid skeletal support, as experienced by Gibson and Davis 1 and described in the cadaveric and clinical studies of Gunter and colleagues. 2
During nasal surgery, when grafting is indicated for dorsal-columellar contour and support, costal cartilage stabilization with K-wire offers precise angulation, ease of formation, and prevents cartilage warping. We think that this effective technique can be enjoyed in limited cases.
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