Section 4 Plastic and Reconstructive Problems

SURGICAL TECHNIQUE

Diced Cartilage Augmentation

Early Experience With the Tasman Technique

Shan R. Baker, MD

umerous methods have been used for dorsal augmentation in reconstructive and aes-

thetic rhinoplasty. The Tasman technique is a method for dorsal augmentation using

diced cartilage solidified by tissue sealant. This article describes the author’s early

experience using the Tasman technique and offers some helpful suggestions to sur-

geons who might wish to use this unique method of preparing a cartilaginous graft.

Arch Facial Plast Surg. 2012;14(6):451-455. Published online June 18, 2012. doi:

10.1001/archfacial.2012.494

Numerous methods have been used for

dorsal augmentation in reconstructive and

aesthetic rhinoplasty. Septal cartilage is the

preferred material for dorsal augmenta-

tion. Septal cartilage grafts tend not towarp

or resorb and are easy to shape and fix-

ate. However, septal cartilage is not al-

ways of adequate amount or quality in re-

vision rhinoplasty.

REVIEW OF DORSAL

GRAFTING MATERIAL

Auricular cartilage harvested from the con-

cha cavum and concha cymba can be par-

tially incised along the graft’s vertical axis

and folded, and the 2 segments can be su-

tured together. Folding it over and sutur-

ing the 2 opposing concave surfaces to-

gether creates a smooth cylindrical dorsal

graft measuring 3.0 cm long and 0.7 to 0.9

cm wide. This technique has the disad-

vantage that it cannot be adapted to dif-

fering height requirements for greater or

less dorsal projection. If used as a single

unfolded graft, auricular cartilage is sub-

ject to warping and distortion as the soft

tissue heals over it.

Costal cartilage typically is the preferred

dorsal graftingmaterial when there is insuf-

ficient septal cartilageavailable fornecessary

dorsalaugmentation.Costalcartilagehasthe

advantage of an ample supply. However,

whentheribgraftiscuttosizeforprecisedor-

sal augmentation, it may warp, becoming

twisted and deformed. Often the grafts are

too thick and result in palpable and some-

timesvisibleedges, particularlywhenplaced

under a thin-skinned envelope. This prob-

lem led Sheen

to cut small strips of costal

cartilage and morselize them into longitu-

dinalstripsforalldorsalreconstructionsusing

costal cartilage.

A solid autogenous graft, whether it is

septal, auricular, or costal cartilage, has the

disadvantage that it must be precisely sculp-

tured to create the ideal size and shape nec-

essary for the ideal dorsum augmentation.

A solid graft by its very nature requires a

larger quantity of tissue because it is denser

than if the same material is diced and used

for a similar degree of dorsum augmenta-

tion. This is because diced cartilage is less

dense, with space interspersed between the

particles of cartilage. This space eventu-

ally is filled with connective tissue as the

graft is successfully integrated. Diced car-

tilage also has the advantage of being eas-

ilymolded and shaped comparedwith solid

or morselized cartilage.

ADVANTAGES

OF DICED CARTILAGE

The advantages of diced cartilage for dor-

sum augmentation have led several sur-

geons to advocate its use. In 1999, Erol

Author Affiliation:

Facial Plastic and Reconstructive Surgery, University of

Michigan–Center for Facial Cosmetic Surgery, Livonia.

ARCH FACIAL PLAST SURG/VOL 14 (NO. 6), NOV/DEC 2012

WWW.ARCHFACIAL.COM

Reprinted by permission of Arch Facial Plast Surg. 2012; 14(6):451-455.