Complications of cartilage and bone grafting to the head and neck

With the exception of blood, bone and cartilage grafts are the most common form of transplanted tissue in the world. Many graft materials are available to utilise in head and neck reconstruction with an array of oncologic, traumatic, congenital and cosmetic applications. Accordingly, it is imperative to understand the complications associated with these grafts, especially in relation to specific materials available.

Infection, warping, resorption and donor site morbidity are the most commonly reported complications in the literature. In relation to cartilage grafts, autologous costal cartilage is the preferred material owing to low immunogenicity and ease of harvest. However, with the disadvantage of donor site morbidity, more recent literature has shown comparable complication rates with allogenic fresh frozen and irradiated costal cartilage. Alloplastic grafts have been associated with concern for a higher risk of complications, although there is a lack of high-quality studies to demonstrate this risk. Bone is subject to similar complications with the exception of graft warping. However, bone grafts are typically used to treat more significant and sizeable defects, which can engender more severe complications.

Complications regarding grafting of cartilaginous and bony material to the head and neck continue to evolve in the literature. Advances in graft material, including the advent of bio-engineered tissue, remain a developing area with auspicious prospects.