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  Bone grafts

Bone Grafts

Bone may be taken from various sites in the body, eg. nose, hip, skull, rib, elbow, etc.

Small pieces of nasal bone may be removed during the course of traditional rhinoplasty and can be re implanted as a graft. A particularly good use for this bone is as a graft to bone gaps at the lateral osteotomies. The lateral osteotomies are cuts made in the nasal skeleton so the nose can be narrowed.

Hip bone grafts were commonly used for nose reconstruction years ago but are now less popular with plastic surgeons because the bone tends to shrink. This is due to the lack of density of the bone, a feature which was helpful for carving it. A very dense bone is more difficult to work with but it has a much better chance of persisting in the nasal skeleton. Apart from the problem of resorption of the graft, the hip can be a painful donor site.

Skull (also called calvarial) bone is very dense and works well for nasal reconstruction. The skull is formed from two layers of bone which are separated by a type of marrow. The outer layer may be removed and used for grafting. This is a delicate procedure! It is possible to cause a fracture of the skull and there is a remote chance of damage to the underlying brain. The use of skull bone is not recommended after the age of 50 years when the outer layer of bone fuses with the inner layer due to disappearance of the marrow (also called diploe).

Rib bone is quite good for grafting into the nose. The hard outer layer of the bone called cortical bone is used. Problems are that the rib is curved, there will be a scar on the chest and the donor site may be painful.

A strip of bone may be taken from the elbow (also called olecranon) and used to build up the nasal bridge line. The bone is not particularly dense but the small quantity that would be harvested is likely to persist in the nose longer than a block of very porous (cancellous) bone from within the hip bone. This scar and minor bone deformity at the elbow are very acceptable.

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