The Role of a Novel Biosynthetic Graft in Nasal Reconstruction

Abstract

Background: Septorhinoplasty is a common procedure, and when native septal cartilage is insufficient for grafting during reconstruction, a variety of alternatives are currently used with varying success. Thus, the aims of this thesis are threefold: 1) summarise the evidence for current alternative grafts, 2) identify emerging alternatives, and 3) assess the feasibility of a novel hybrid graft in nasal reconstruction.

Methods: The first chapter of this thesis establishes a foundational understanding of the anatomy and function of the nose and septorhinoplasty. This contextualises the second chapter which utilises a systematic review of the literature to qualitatively evaluate complication rates of current alternative grafts. Furthermore, emerging alternatives are summarised. One of these emerging grafts, a hybrid bioactive-polymer scaffold (actv-graft®), is then used in a feasibility study in three sheep after ethics approval and grant acquisition in chapter 3.

Results: The results of six systematic reviews were qualitatively synthetised in chapter 2. Biologic grafts were generally associated with higher rates of warping, revision surgery, donor-site morbidity, and resorption. Synthetic grafts were more commonly associated with extrusion, infection, and removal surgery. No single alternative graft was ideal. Tissue-engineering and hybrid bioactive-polymer scaffolds were identified as two emerging fields. In chapter 3, actv-graft® was found to be biocompatible, biodegradable, have favourable volume augmentation over time, and stimulate host infiltration within the graft.

Conclusion: Cost-effective, easily procured, patient-specific, bioactive, and biodegradable scaffolds are required in septorhinoplasty. This thesis establishes the feasibility of a promising graft. However, a longer and larger cohort animal study would aid in characterising the safety profile, chondrogenic potential, and degradation rate of actv-graft® prior to human trials.