[Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction]

Laryngorhinootologie. 2000 Mar;79(3):155-9. doi: 10.1055/s-2000-289.
[Article in German]


Introduction: In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy.

Technique: In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications.

Discussion: This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.

Publication types

  • English Abstract

MeSH terms

  • Anesthetics, Local / administration & dosage*
  • Cartilage / transplantation*
  • Catheterization
  • Humans
  • Pain, Postoperative / prevention & control*
  • Ribs / surgery*
  • Surgical Instruments
  • Transplantation, Autologous


  • Anesthetics, Local