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      Cartilage Allografts for Aesthetic Nose Surgery: A Viable Option

      research-article
      , MD , , MD
      Plastic and Reconstructive Surgery Global Open
      Wolters Kluwer Health

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          Abstract

          Background:

          Illusions in rhinoplasty are a powerful tool yet often overlooked. There are numerous examples of how a specific change in 1 part of the nose will influence the balance of the nose on the entire face. Although cartilage autograft remains the gold standard in structural reconstruction of the nose, for selected cases, allografts can be favored.

          Methods:

          A retrospective cohort study was performed on all patients who underwent cartilage allograft for aesthetic nose surgery from January 2012 to June 2017. All patients were informed of the therapeutic and experimental nature of the localized cartilage allograft use and then consented to the procedure orally and in writing. From January 2012 to June 2017, a total of 105 patients were operated on using cartilage allografts.

          Results:

          Of these 105 patients, follow-up to a year was achieved in 97.

          Conclusion:

          The use of cartilage allograft in our practice has been a useful proven tool that can help manage a patient aesthetic outcome. This gives us the opportunity for cartilage banking and thus, using it, fewer incisions and scars on our patients.

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          Most cited references7

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          Success rates and immunologic responses of autogenic, allogenic, and xenogenic treatments to repair articular cartilage defects.

          This review examines current approaches available for articular cartilage repair, not only in terms of their regeneration potential, but also as a function of immunologic response. Autogenic repair techniques, including osteochondral plug transplantation, chondrocyte implantation, and microfracture, are the most widely accepted clinical treatment options due to the lack of immunogenic reactions, but only moderate graft success rates have been reported. Although suspended allogenic chondrocytes are shown to evoke an immune response upon implantation, allogenic osteochondral plugs and tissue-engineered grafts using allogenic chondrocytes exhibit a tolerable immunogenic response. Additionally, these repair techniques produce neotissue with success rates approaching those of currently available autogenic repair techniques, while simultaneously obviating their major hindrance of donor tissue scarcity. To date, limited research has been performed with xenogenic tissue, although several studies demonstrate the potential for its long-term success. This article focuses on the various treatment options for cartilage repair and their associated success rates and immunologic responses.
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            Cartilage immunoprivilege depends on donor source and lesion location.

            The ability to repair damaged cartilage is a major goal of musculoskeletal tissue engineering. Allogeneic (same species, different individual) or xenogeneic (different species) sources can provide an attractive source of chondrocytes for cartilage tissue engineering, since autologous (same individual) cells are scarce. Immune rejection of non-autologous hyaline articular cartilage has seldom been considered due to the popular notion of "cartilage immunoprivilege". The objective of this study was to determine the suitability of allogeneic and xenogeneic engineered neocartilage tissue for cartilage repair. To address this, scaffold-free tissue engineered articular cartilage of syngeneic (same genetic background), allogeneic, and xenogeneic origin were implanted into two different locations of the rabbit knee (n=3 per group/location). Xenogeneic engineered cartilage and control xenogeneic chondral explants provoked profound innate inflammatory and adaptive cellular responses, regardless of transplant location. Cytological quantification of immune cells showed that, while allogeneic neocartilage elicited an immune response in the patella, negligible responses were observed when implanted into the trochlea; instead the responses were comparable to microfracture-treated empty defect controls. Allogeneic neocartilage survived within the trochlea implant site and demonstrated graft integration into the underlying bone. In conclusion, the knee joint cartilage does not represent an immune privileged site, strongly rejecting xenogeneic but not allogeneic chondrocytes in a location-dependent fashion. This difference in location-dependent survival of allogeneic tissue may be associated with proximity to the synovium.
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              Fundamental Principles in Aesthetic Rhinoplasty

              This review article will highlight several fundamental principles and advances in rhinoplasty. Nasal analysis has become more sophisticated and thorough in terms of breaking down the anomaly and identifying the anatomic etiology. Performing this analysis in a systematic manner each time helps refine these skills and is a prerequisite to sound surgical planning. Dorsal augmentation with alloplastic materials continue to be used but more conservatively and often mixed with autogenous grafts. Long term outcomes have also taught us much with regards to wound healing and soft tissue contracture. This is best demonstrated with a hump reduction where the progressive pinching at the middle vault creates both aesthetic and functional problems. Correcting the twisted nose is challenging and requires a more aggressive intervention than previously thought. Both cartilage and soft tissue appear to have a degree of memory that predispose to recurrent deviations. A complete structural breakdown and destabilization may be warranted before the nose is realigned. This must be followed by careful and meticulous restabilization. Tip refinement is a common request but no single maneuver can be universally applied; multiple techniques and grafts must be within the surgeon's armamentarium.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                06 September 2018
                September 2018
                : 6
                : 9
                : e1859
                Author notes
                German Vargas, MD, 3a calle A 8–38 zona 10, Edificio Renova, Guatemala, Guatemala, E-mail: gvargas@ 123456renova.com.gt
                Article
                00006
                10.1097/GOX.0000000000001859
                6191223
                8387b566-e2ab-4e93-834a-df659fcd0e58
                Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 19 March 2018
                : 14 May 2018
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