Double-Reversed Costal Cartilage Graft for Nasal Reconstruction

Costal cartilage provides the ideal graft for reconstruction of the nasal dorsum and tip because of its abundant supply and flexural strength. Nevertheless, autologous costal cartilage grafts can experience warping. Several techniques have been devised to offset the intrinsic warping effects of cartilage, but current techniques have several disadvantages. The authors present a multimedia demonstration of the double-reversed technique for costal cartilage reconstruction. This strategy is unique in its dual axis of rotation to offset warp in all dimensions. This technique can be performed with conventional instruments, does not introduce foreign material, and provides robust support to counteract the often scarred and contracted soft-tissue envelope.