Clinical Review & Education

Surgical Pearls

A Single Incision for Harvesting Conchal Cartilage and

Temporal Fascia in Diced Cartilage–Fascia Grafts
Sarju S. Vasani, FRCS(ORL-HNS); Rajesh Anmolsingh, MBBS; Ivor Kwame, MRCS; Charles East, FRCS

Rhinoplasty surgery using diced cartilage grafts has been modified
several times since its inception. The “Turkish delight” technique de-
veloped by Erol1 includes the insertion of diced cartilage wrapped in
Surgicel (Ethicon Inc). However Calvert et al2 reported that graft ab-
sorption frequently ensued.
Daniel3 therefore recommended
Video at
jamafacialplasticsurgery.com
the use of a deep temporal fas-
cia wrapper creating a diced car-
tilage–fascia (DCF) graft instead of Surgicel.3 This modification led to
grafts maintaining longer chondrocyte viability.4,5 The use of tempo-
ral fascia has the disadvantage of requiring a further incision, which
is not necessary if using Surgicel or autologous tissue glue.6
We aimed to introduce a modified single incision for harvest-
ing both conchal cartilage graft and temporal fascia, with the objec-
tive of improving the aesthetic outcome of the procedure as well as
reducing perioperative time. This technique is particularly useful in
secondary rhinoplasty surgery, where septal cartilage may be in short
supply.
Surgical Technique
We present a Video describing and illustrating the process of nasal
augmentation using a DCF graft. The procedure shown has been per-
formed on a patient with a repaired cleft palate and was carried out
via an open septorhinoplasty approach with an asymmetric inci-
sion for V-Y lengthening of left nostril.
Discussion
The success of dorsal nasal augmentation is measured by the aes-
thetic outcome as well as the survivability of the graft. Autolo-
gous grafts have distinct advantages over nonautologous grafts—
they have greater longevity and simultaneously provide a natural
contour without the complications related to biocompatibility.
Other advantages include the ready availability from the patient,
lower rate of infections, and potential extrusion of synthetic
graft.6
The long-term outcome of Erol’s “Turkish delight” technique1 was
disputed by Calvert et al2 who concluded that Surgicel has a delete-
rious effect on the viability of diced cartilage.
These points give heavy weighting to the use of fascia as a
wrapper in dorsal augmentation. The approximately 3-cm trans-
verse incision over the temporal fascia harvest site 3 can be
in addition to that incision used to harvest costochondral or
auricular cartilage. The reduced number of incisions in this tech-
nique therefore decreases extra complications of an additional
wound including scarring, pain, infection, and dehiscence. The
site of incision also increases the aesthetic value because the cra-
nial aspect can be well hidden under the hairline as well as behind
the ear.
We wish to add to the current practice of diced cartilage with
fascial grafting by offering this modified incision technique. We be-
lieve that this is a useful and worthwhile adaptation.

ARTICLE INFORMATION
Author Affiliations: Royal National Throat, Nose
and Ear Hospital, London, England (Vasani,
Anmolsingh, Kwame, East); University College
London Hospitals NHS Trust, London, England
(East).
Corresponding Author: Sarju S. Vasani,
FRCS(ORL-HNS), Royal National Throat, Nose and
Ear Hospital, 330 Gray’s Inn Rd, London WC1X 8DA,
England (dr_s_vasani@hotmail.com).
Published Online: June 19, 2014.
doi:10.1001/jamafacial.2014.234.
Conflict of Interest Disclosures: None reported.
REFERENCES
1. Erol OO. The Turkish delight: a pliable graft for
rhinoplasty. Plast Reconstr Surg. 2000;105(6):
2229-2242.
2. Calvert JW, Brenner K, DaCosta-Iyer M, Evans
GR, Daniel RK. Histological analysis of human diced
cartilage grafts. Plast Reconstr Surg. 2006;118(1):
230-236.
3. Daniel RK. Diced cartilage grafts in rhinoplasty
surgery: current techniques and applications. Plast
Reconstr Surg. 2008;122(6):1883-1891.
4. Brenner KA, McConnell MP, Evans GRD, Calvert
JW. Survival of diced cartilage grafts: an experimental
study. Plast Reconstr Surg. 2006;117(1):105-115.
5. Coskun BU, Seven H, Yigit O, et al. Comparison of
diced cartilage graft wrapped in surgicell and diced
cartilage graft wrapped in fascia: an experimental
study. Laryngoscope. 2005;115(4):668-671.
6. Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E.
A novel autologous scaffold for diced-cartilage
grafts in dorsal augmentation rhinoplasty. Aesthetic
Plast Surg. 2011;35(4):569-579.

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