11.1 Harvesting Graft Material

Atraumatic tissue harvesting is essential for successful grafting. Septal cartilage should be dissected in the subperichondrial plane, conchal cartilage in the supraperichondrial plane. The tissue should not be injured or crushed when harvested.

Perichondrium does not protect the graft from resorption and should therefore be dissected off the cartilage. ³ For grafting in children, however, the perichondrium should remain on the graft so that it can provide a chondroplastic function. Meticulous, definitive hemostasis is important after graft harvest to prevent hematoma formation in the septum or ear. Not infrequently, this complication may become the main problem during postoperative care. The conchal cavity should be packed with ointment-impregnated cottonwool after graft harvest to promote adhesion of the skin layers. The harvested material is prepared for use on a small carving bench with a millimeter scale ( Fig. 11.1 ).

After the size of the recipient defect has been measured with a plastic surgical caliper (Karl Storz, Tuttlingen, Germany), the size and shape of the graft are precisely marked with a color marker ⁴ while the graft is held with a blunt Adson forceps. Either that instrument or a Rubin cartilage squeezer can be used to work on the cartilage. Tension can be removed from the graft by cross-hatching or incising its concave side to prevent graft deformation at the recipient site.