Current practice in autologous rib and costal-cartilage harvest for rhinoplasty: A systematic review

Background Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction. However, surgeons worldwide have not agreed on the details of graft harvesting, including rib selection, side preference, operation mode, cutting methods, and handling of the periosteum and perichondrium. This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5 years and identify potential avenues for future research. Methods We searched for related articles in PubMed, Embase, and Web of Science from 2019 to 2023, summarized crucial but controversial steps in recent practice, and analyzed their theoretical basis and clinical feasibility. Results Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction, with the 5th to 8th ribs and cartilage being the most used. The laparoscopic harvest is gaining attention, being second only to the open harvest, with the 9th/10th ribs and cartilages being particularly convenient. The clinical applications of full-cut and split-cut methods differ in their advantages. Except for some special reasons, almost all studies tended to preserve the periosteum and perichondrium in situ, and few surgeons chose to harvest the grafts on the left side. Conclusion Multiple techniques have emerged, requiring surgeons to balance the benefits and risks of various strategies at each step. New theories and techniques should be fully tested promptly and in clinical practice before wide application. Overall, a professional consensus is needed for better directivity, precision, and stability in clinical practice.