Costal Cartilage Allograft Processing and User Patterns in Rhinoplasty

BACKGROUND: Specific allograft processing methods may contribute to high failure rates. OBJECTIVES: To characterize commonly used proprietary costal cartilage allograft processing techniques among tissue banks and assess surgeon preferences for graft sterilization methods in rhinoplasty. METHODS: A comprehensive review of American Association of Tissue Banks (AATB)-certified cartilage providers was performed using public databases, United States Patent and Trademark Office records, PubMed, and consultation with research scientists. An international survey of rhinoplasty surgeons in the Evidence-Based Rhinoplasty Reading Group assessed allograft preferences for rhinoplasty. RESULTS: Among 41 AATB-certified cartilage providers, 12 distinct proprietary processing protocols were identified. Gamma irradiation (1.0-5.0 Mrad) was used in 63.6% of methods. Peroxide-based detergents, including hydrogen peroxide, were used in 36.4%, and alcohol-based detergents, including isopropyl alcohol, in 36.4%. Antibiotic or aseptic solutions (bacitracin, polymyxin B, gentamicin) were incorporated in 45.4% of protocols. Survey respondents favored fresh-frozen costal cartilage allograft, although most surgeons (74.6%) reported exclusive use of autologous costal cartilage. CONCLUSIONS: Substantial heterogeneity exists in costal cartilage allograft processing methods and surgeon selection preferences. Variability in processing may contribute to differences in reported clinical outcomes. Greater understanding of these methods may guide future research and support evidence-based graft selection.