Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique
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Objectives. Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. Methods. Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. Results. The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. Conclusion. The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.
Abstract
Objectives. Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. Methods. Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. Results. The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. Conclusion. The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.
참고문헌 (26)
- Males AG, "Mastoid misery: quantifying the distress in a radical cavity", Clin Otolaryngol Allied Sci, 16(1), pp.12~14 (1991)
- Whittemore KR Jr, "Acoustic mechanisms: canal wall-up versus canal wall-down mastoidectomy", Otolaryngol Head Neck Surg, 118(6), pp.751~761 (1998)
- Shelton C, "Tympanoplasty: review of 400 staged cases", Laryngoscope, 100(7), pp.679~681 (1990)
- Takahashi H, "Mastoid obliteration combined with soft-wall reconstruction of posterior ear canal", Eur Arch Otorhinolaryngol, 264(8), pp.867~871 (2007)
- Gantz BJ, "Canal wall reconstruction tympanomastoidectomy with mastoid obliteration", Laryngoscope, 115(10), pp.1734~1740 (2005)
- Kim SH, "Epitympanoplasty with mastoid obliteration technique in middle ear surgery:12-year result", Int Adv Otol, 5(1), pp.24~30 (2009)
- Shea MC Jr, "Mastoid obliteration using homogenous bone chips and autogenous bone paste", Am Acad Ophthalmol Otolaryngol, 76(1), pp.160~172 (1972)
- Grote JJ., "Results of cavity reconstruction with hydroxyapatite implants after 15 years", Am J Otol, 19(5), pp.565~568 (1998)
- 이한빈, "Clinical Significance of β-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study", Clinical and Experimental Otorhinolaryngology, 6(3), pp.127~134 (2013), 대한이비인후과학회
- Jang CH, "Mastoid obliteration using a hyaluronic acid gel to deliver a mesenchymal stem cells-loaded demineralized bone matrix: an experimental study", Int J Pediatr Otorhinolaryngol, 72(11), pp.1627~1632 (2008)
- Leatherman BD, "The use of demineralized bone matrix for mastoid cavity obliteration", Otol Neurotol, 25(1), pp.22~25 (2004)
- 조성우, "Mastoid Obliteration with Silicone Blocks after Canal Wall Down Mastoidectomy", Clinical and Experimental Otorhinolaryngology, 5(1), pp.23~27 (2012), 대한이비인후과학회
- Black B, "Mastoidectomy elimination", Laryngoscope, 105(12 Pt 2 Suppl 76), pp.1~30 (1995)
- Black B, "Mastoidectomy elimination: obliterate, reconstruct, or ablate?", Am J Otol, 19(5), pp.551~557 (1998)
- Leatherman BD, "Demineralized bone matrix as an alternative for mastoid obliteration and posterior canal wall reconstruction: results in an animal model", Otol Neurotol, 22(6), pp.731~736 (2001)
- Moon BJ, "Outcomes following rhinoplasty using autologous costal cartilage", Arch Facial Plast Surg, 14(3), pp.175~180 (2012)
- Siegert R, "Combined reconstruction of congenital auricular atresia and severe microtia", Laryngoscope, 113(11), pp.2021~2027 (2003)
- Cotton RT, "O’Connor DM, Smith ME. Pediatric laryngotracheal reconstruction with cartilage grafts and endotracheal tube stenting: the single-stage approach", Laryngoscope, 105(8 Pt 1), pp.818~821 (1995)
- Uppal RS, "Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity", Plast Reconstr Surg, 121(6), pp.1949~1955 (2008)
- Baryza MJ, "The Vancouver Scar Scale: an administration tool and its interrater reliability", J Burn Care Rehabil, 16(5), pp.535~538 (1995)
- Draaijers LJ, "The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation", Plast Reconstr Surg, 113(7), pp.1960~1965 (2004)
- Rasp G, "Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction", Laryngorhinootologie, 79(3), pp.155~159 (2000)
- Chepla KJ, "Late complications of chest wall reconstruction: management of painful sternal nonunion", Semin Plast Surg, 25(1), pp.98~106 (2011)
- Scott J, "Graphic representation of pain", Pain, 2(2), pp.175~184 (1976)
- Joyce CR, "Comparison of fixed interval and visual analogue scales for rating chronic pain", Eur J Clin Pharmacol, 8(6), pp.415~420 (1975)
- Jensen MP, "Increasing the reliability and validity of pain intensity measurement in chronic pain patients", Pain, 55(2), pp.195~203 (1993)