INTRODUCTION: Autologous diced cartilage grafts (DCG), wrapped in various matrices, are utilized to provide dorsal nasal height without irregularities or buckling reflected on the surface, otherwise observed with the use of block cartilages. The matrices used to contain the DCG have the disadvantage of unpredictable resorption rate, which is due to different survival rates of the envelope. Some lacking the optimum porosity, thus decreasing the contact between the cartilage and the recipient site, and delaying the graft take. A matrix, not acting as an envelope, with optimal adhesivity and malleability characteristics, is ideal. Autologous fibrin glue (AFG) performs well with its cohesivity and adhesivity. The bio-support provided by the growth factors in the platelet-rich plasma is also an additional benefit. However, in our experience with AFG, we frequently observed a skin reaction and redness in the nose, which is possibly due to the use of allogenic thrombin. Therefore, we developed a method to accelerate cross linking of the autologous plasma eliminating thrombin, ACD-A, and CaCl use.
MATERIALS AND METHODS: 34 patients experienced nasal dorsal restoration. After dicing the cartilage, the required volume is calculated with a silicon spacer. 20cc of the patient’s blood is harvested without using any anti-clotting agent. It is immediately centrifuged in 4 sessions. 45, 90, 180 and 360 seconds respectively.. Each centrifuge provides separate fractionates. These 4 fractionates combined with diced cartilage, and placed in a silicon tube. Random vector resonance (RVR) is applied to the silicon tube containing the graft for 5 minutes. Then, using the tube, the graft is inserted into the defect area. The applied mean graft volume was 1.9 cc.
RESULTS: The results were evaluated at 6 months.. By comparing lateral view pictures, dorsal height was seen to be preserved in all patients. No significant resorption was observed. In 5 cases over-corrections needed further reductions. CONCLUSION: The conservation of the initial volume is due to the spontaneous accelerated cross-linking and elimination of the envelope. The use of thrombin and Ca is responsible for the long standing reaction observed in conventional PRP procedures. .Four segment centrifuge separates the substrate each time, which otherwise will cause premature clotting which happens when performed in single 4 minute centrifuge). Therefore separation of 4 fractions separated accordingly with molecular weight, clears the coagulation substrate and keeps them non-clotted to be mixed with diced cartilage. Additionally, RVR accelerates cross-linking for early stabilization of the graft.