Ocationally I operate Western patients like the Westerns operate Asians once in a while. However I operated Asians for over 10 years everyday. Asians usually come for augmentation and on the contrary Westerns come for reduction rhinoplasty. With rib cartilage I have done more than 1000 cases. Gunter and Daniel mention K-wire but that's in a very special case and examples of the surgery are not enough.
The nose has a delicate curvature. Nevertheless the insertion of the straight k-wire is only possible during secondary rhinoplasty.Also you mentioned that he used half rib half cartilage and uses k-wire; however the rate of absoption of the bone is much higher. It can cause change in shape gradually.
We have many ways to prevent warping.Articles about it will be soon published in this magazine called "Plastic Reconstructive Surgery." It is not necessary to remove the k-wire after 10 days with another troublesome surgery. It doens't mean that warping won't occur just because it doens't happen in 10 days. 10 days are short to predict anything.


나도 서양인들을 가끔 수술한다. 가끔 서양인들이 동양인을 가끔 수술하듯이
하지만 동양인은 매일 십여년 이상 해왔다. 동양인은 올리는 수술 서양인은 줄이는 수술이다.
rib car. 만 1000례 이상을 수술하였다. Gunter나 Daniel이 K-wire를 이야기 하지만 그건 아주 특별한 경우이고 수술예도 아주 작을 것을 생각한다.

코는 미묘한 curvature를 가지고 있다. 그런데 직선의 k-wire를 삽입하는 것은 재건수술에서나 가능한 일이다. 또한 rib cartilage와 bone을 반씩 쓴다고 하지만 bone의 흡수율은 훨씬 높다.  나중에 모양의 변형이 올 수 있다.
우리는 warping을 막을 수 있는 여러 방법들은 가지고 있다. 그런 내용은 Plastic Reconstructive & Surgery라는 잡지에 곧 piblish 될 것이다. 10일 후에 또 한번의 수술로 번거롭게 K-wire를 제거하지 않아도 된다. warping은 10일 후라고 안 일어나는 것이 아니다.



>Hi dr.jung are you familiar with this doctor's approach to rib removal? (he uses half rib half cartilage and uses k-wire and removes the k-wire in 10 days)
>can you please read it and tel me if if this is the same thing that you do with rib grafts? thanks
>heres what Dr.Daniel does:
>
>"In his book "Rhinoplasty: an atlas of surgical techniques" pp 270-276 Dr Rollin Daniel describes his technique to prevent rib graft warping he says that he uses the 9th rib but he uses half bone half cartilage as opposed to pure cartilage. He says its advantages are:
>
>-Minimal risk of warping
>-Maximum chance of bone survival
>-Minimum postoperative pain
>
>Daniel says that he places temporary K-wires through the graft to provide rigid fixation and union of the bony part of the graft with the nose for long-term survival. But after 10 days he removes the K-wires. At the end of page 276 he says "warping is rarely a problem with osseocartilaginous grafts as compared to pure costal cartilage grafts".
>
>I guess this method obviously eliminates the risks of K-wire because they are removed 10 days postoperatively.

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