How would you like your cartilage served – diced, crushed or shaved?
Reviewed by Shivanchan Rajmohan

Harvested cartilage can be used to enhance the structural, functional and aesthetic properties of the nose in rhinoplasty. The practice of mechanical fragmentation of harvested cartilage in rhinoplasty is varied with no clear consensus with respect to its indication. This systematic review comprised 30 studies over a 23-year period inspecting  outcomes of three cartilage fragmentation techniques (shaved, diced, and crushed) in addition to outcomes of injectable versus noninjectable cartilage grafts in rhinoplasty. Resorption rates and revision rates were investigative outcomes of this review. From a total of 14,870 patients, 10,599 subjects underwent primary rhinoplasty and 86.7% of studies  utilised the diced fragmentation technique while 25% of studies employed the injectable cartilage implantation technique. The most common indication was dorsal augmentation or camouflaging, with the septum being the commonly utilised donor site followed by concha and costal cartilages. Noteworthy is the use of mixed or wrapped cartilage grafts in 40% of incorporated studies with autogenous constituents including fat, fascia, and platelet-rich plasma. Mean total resorption rates were 9.22%, 0% and 2.4% for diced, shaved, and crushed fragmentation techniques respectively, though shaved fragmentation displayed higher mean partial resorption rates compared to diced fragmentation grafts. Mean revision rates were 10.45%, 5% and 3% for diced, shaved, and crushed fragmentation techniques respectively. Injectable grafts had higher partial resorption, but lower revision rates compared to non-injectable grafts. Of all the studies, 16.7% declared postoperative infection with mechanically fragmented cartilage grafts. Mechanically fragmented cartilage grafts remain a viable option in rhinoplasty conferring less visibility, however one must consider various factors including viability of harvested cartilage and, hence, ability to attain desired postoperative appearance. Further studies are needed to examine resorption rates of mechanically fragmented cartilage grafts in primary versus secondary rhinoplasty.

Mechanically fragmented cartilage grafts in rhinoplasty: An up-to-date systematic review.
Segreto F, Marianetti T, Iademarco A, et al.
J PLAST RECONSTR AESTHET SURG
2024;95:250–65.