20910 Cartilage graft; costochondral

Name of the Procedure:

Cartilage Graft; Costochondral
Common names: Costochondral graft, Rib cartilage graft, Costochondral autograft

Summary

In simple terms, a costochondral cartilage graft procedure involves taking a piece of cartilage and its underlying bone from a patient's rib and using it to repair or reconstruct damaged areas of cartilage in another part of the body, such as the nose, ear, or joints.

Purpose

The primary goal of this procedure is to repair or replace damaged cartilage due to trauma, congenital defects, or disease. Expected outcomes include restored function, improved structural integrity, and enhanced appearance of the affected area.

Indications

This procedure is indicated for patients who have:

• Cartilage damage from injury or trauma
• Congenital deformities requiring structural support, such as microtia (underdeveloped ear)
• Joint reconstruction needs, particularly in conditions like temporomandibular joint disorders
• Nasal reconstruction needs after injury or previous surgery

Preparation

Patients are typically instructed to:

• Fast for at least 8 hours before the procedure
• Adjust or discontinue certain medications, as advised by their healthcare provider
• Undergo preoperative assessments, which may include blood tests, imaging studies, and physical examination
• Avoid smoking to enhance healing

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A small incision is made over the rib area to harvest the cartilage and bone.
3. Harvesting Graft: The surgeon carefully removes the required piece of the rib cartilage and bone, preserving the surrounding structures.
4. Implantation: The harvested graft is then meticulously shaped and implanted into the target area needing reconstruction.
5. Closure: The incision site is closed with sutures, and a dressing is applied.

Tools and equipment used include surgical scalpels, retractors, sutures, and specialized instruments for cartilage shaping.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity of the reconstruction.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

Healthcare professionals involved commonly include:

• Lead Surgeon
• Surgical Nurses
• Anesthesiologist
• Surgical Assistants

Risks and Complications

Common risks include:

• Infection
• Bleeding
• Bruising

Rare complications may involve:

• Graft rejection or absorption
• Rib deformity or fracture
• Breathing difficulties if lung or pleura is inadvertently affected

Benefits

The main benefits are:

• Restoration of function and structural integrity in the affected area.
• Improved aesthetic outcome Patients typically begin to see the benefits within the first few weeks as they heal.

Recovery

Post-procedure care involves:

• Pain management using prescribed medications
• Instructions to keep the incision area clean and dry
• Avoiding strenuous activities for a few weeks
• Follow-up appointments for evaluation and stitch removal The expected recovery time is generally 4-6 weeks, with specific restrictions based on the surgery site.

Alternatives

Other treatment options might include:

• Synthetic implants: Pros—no donor site pain; Cons—risk of rejection or long-term complications
• Tissue engineering approaches: Pros—use of patient's own cells; Cons—experimental and not widely available
• Observation or conservative management: Pros—non-invasive; Cons—may not address the problem adequately

Patient Experience

During the procedure, the patient will be under general anesthesia and should not feel any pain. Post-procedure, patients may experience pain and discomfort at both the donor and recipient sites, which can be managed with prescribed pain relief measures. Swelling and bruising are typical but should subside over several weeks. Comfort measures include ice packs, rest, and careful movement to ease discomfort.