The Effect of Perichondrium on Biological and Biomechanical Properties of Molded Diced Cartilage Grafts

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Diced cartilage is a significant alternative approach to cartilage grafting. However, the viability and biomechanical properties of diced cartilage grafts remain to be improved, and the role of perichondrium is largely neglected. This study aimed to evaluate the histological and biomechanical effects of perichondrium on custom-shaped diced cartilage grafts constructed via a high-density porous polyethylene mold.


Seven New Zealand rabbits were used. Unilateral auricular cartilage was harvested and divided into 2 parts, with or without perichondrium, diced into 1 × 1 × 0.5 mm cubical pieces, and filled into high-density porous polyethylene molds. Three grafts with the perichondrium removed and 3 with the perichondrium preserved were implanted subcutaneously at the dorsum. The grafts underwent biomechanical and histological tests 4, 8, and 12 weeks after the implantation.


The diced cartilage merged into integrated blocks without observable resorption in both groups at each time point. Additionally, the retention rate of weight was higher in the perichondrium-preserved group (P < 0.05). We observed regenerated cartilage that stained positively for type II collagen and glial fibrillary acidic protein (GFAP). A greater area of regenerated cartilage and higher scores of GFAP staining were observed in the perichondrium-preserved group (P < 0.05). The yield stress and modulus of elasticity were also higher in the perichondrium-preserved grafts from week 8 after implantation (P < 0.05).


Diced cartilage grafts with a custom shape can be constructed using a high-density porous polyethylene mold. The preservation of perichondrium can improve graft viability and biomechanical properties.

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  1. 1.

    Peer LA (1948) Reconstruction of the auricle with diced cartilage grafts in a vitallium ear mold. Plast Reconstr Surg 3:653–666

  2. 2.

    Erol OO (2000) The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 105:2229–2243

  3. 3.

    Celik M, Haliloglu T, Baycin N (2004) Bone chips and diced cartilage: an anatomically adopted graft for the nasal dorsum. Aesthet Plast Surg 28:8–12

  4. 4.

    Erol OO (2016) Long-term results and refinement of the Turkish delight technique for primary and secondary rhinoplasty: 25 years of experience. Plast Reconstr Surg 137:423–437

  5. 5.

    Liao JL, Chen J, Xu JQ, Cheng Y, Xie HJ, He G, He B, Cao K, Xie HQ, Zhou JD (2017) Viability and biomechanics of bare diced cartilage grafts in experimental study. J Craniofac Surg 28:1445–1450

  6. 6.

    Brenner KA, McConnell MP, Evans GR, Calvert JW (2006) Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg 117:105–115

  7. 7.

    Daniel RK, Calvert JW (2004) Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113:2156–2171

  8. 8.

    Kelly MH, Bulstrode NW, Waterhouse N (2007) Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation. Plast Reconstr Surg 120:1654–1659

  9. 9.

    Gordon CR, Alghoul M, Goldberg JS, Habal MB, Papay F (2011) Diced cartilage grafts wrapped in AlloDerm for dorsal nasal augmentation. J Craniofac Surg 22:1196–1199

  10. 10.

    Kim HK, Chu LS, Kim JW, Park B, Kim MK, Bae TH, Kim WS (2011) The viability of diced cartilage grafts wrapped in autogenous fascia and AlloDerm (R) in a rabbit model. J Plast Reconstr Aesthet Surg 64:193–200

  11. 11.

    Guler I, Billur D, Aydin S, Kocaturk S (2015) Efficacy of platelet-rich fibrin matrix on viability of diced cartilage grafts in a rabbit model. Laryngoscope 125:104–111

  12. 12.

    Goral A, Aslan C, Bolat Kucukzeybek B, Isik D, Hosnuter M, Durgun M (2016) Platelet-rich fibrin improves the viability of diced cartilage grafts in a rabbit model. Aesthet Surg J 36:153–162

  13. 13.

    Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E (2011) A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg 35:569–579

  14. 14.

    Tasman AJ, Suarez GA (2015) The diced cartilage glue graft for radix augmentation in rhinoplasty. JAMA Facial Plast Surg 17:303–304

  15. 15.

    Orbay H, Tobita M, Hyakusoku H, Mizuno H (2012) Effects of adipose-derived stem cells on improving the viability of diced cartilage grafts. Plast Reconstr Surg 129:369–377

  16. 16.

    Hafezi F, Bateni H, Naghibzadeh B, Nouhi AH, Emami A, Fatemi SJ, Pedram M, Mousavi SJ (2012) Diced ear cartilage with perichondrial attachment in rhinoplasty: a new concept. Aesthet Surg J 32:825–832

  17. 17.

    Kemaloğlu CA, Tekin Y (2014) A comparison of diced cartilage grafts wrapped in perichondrium versus fascia. Aesthet Plast Surg 38:1164–1168

  18. 18.

    Kim JH, Jang YJ (2015) Use of diced conchal cartilage with perichondrial attachment in rhinoplasty. Plast Reconstr Surg 135:1545–1553

  19. 19.

    Liao JL, Chen J, He B, Chen Y, Xu JQ, Xie HJ, Hu F, Wang AJ, Luo C, Li QF, Zhou JD (2017) Viability and biomechanics of diced cartilage blended with platelet-rich plasma and wrapped with poly(lactic-co-glycolic) acid membrane. J Craniofac Surg 28:1418–1424

  20. 20.

    Yilmaz S, Ercocen AR, Can Z, Yenidunya S, Edali N, Yormuk E (2001) Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 108:1054–1062

  21. 21.

    Fatemi MJ, Hasani ME, Rahimian S, Bateni H, Pedram M, Mousavi SJ (2012) Survival of block and fascial-wrapped diced cartilage grafts: an experimental study in rabbits. Ann Plast Surg 69:326–330

  22. 22.

    Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S (2017) Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg 140:461–470

  23. 23.

    Liao J, Chen Y, Chen J, He B, Qian L, Xu J, Wang A, Li Q, Xie H, Zhou J (2019) Auricle shaping using 3D printing and autologous diced cartilage. Laryngoscope.

  24. 24.

    Patel K, Brandstetter K (2016) Solid Implants in Facial Plastic Surgery: Potential Complications and How to Prevent Them. Facial Plast Surg 32:520–531

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Correspondence to Hui Wang or Hua Jiang.

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The study protocol was approved by the Animal Experiments Ethics Committee of the Institutional Review Board and all procedures complied with the national Laboratory Animal Administration Rules of China.

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Shi, Y., Guo, R., Hou, Q. et al. The Effect of Perichondrium on Biological and Biomechanical Properties of Molded Diced Cartilage Grafts. Aesth Plast Surg (2020) doi:10.1007/s00266-019-01581-5

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  • Diced cartilage
  • Perichondrium
  • Biomechanical property
  • Rhinoplasty
  • Auricular cartilage
  • High-density porous polyethylene mold