Comparison of Polypropylene and Polydioxanone in the Hemitransdomal Suture: A Novel Rabbit Ear Cartilage Model.

BACKGROUND: Lower lateral cartilage reshaping is one of the basic steps in rhinoplasty. Hemitransdomal suture is frequently used for dome narrowing. Different suture materials can be used for hemitransdomal suture. In this study, we investigated the effectiveness of polypropylene and polydioxanone in hemitransdomal suture by designing a new experimental model in the rabbit ear cartilage. METHODS: Twelve young adult male New Zealand White rabbits were used. The bipedicled inverted-U-shaped cartilage was elevated in each ear of the rabbits. Two hemitransdomal sutures were applied using 5-0 polypropylene on one ear and 5-0 polydioxanone on the other ear randomly. A 5 mm high cartilage mound was created with two hemitransdomal sutures on each side. The sample size was twelve both in the polypropylene group and the polydioxanone group (n = 12). All animals were sacrificed after three months. Cartilage mound heights were measured. The samples were examined histologically regarding fibroadipose tissue, inflammation, foreign body granuloma, cartilage degeneration, and the presence of inclusion cyst. RESULTS: Cartilage mound height was significantly higher in the polypropylene group than in the polydioxanone group at the end of the third month [3.75 mm (± 0.68) vs. 3.03 mm (± 0.69); p < 0.05]. There was no significant difference between the two groups in histological analysis (p > 0.05). CONCLUSIONS: Polypropylene suture may be more effective in maintaining the shape given to the dome by hemitransdomal sutures in rhinoplasty. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Scarless Method for Correcting Tanzer Group IIB-Constricted Ear Without Cartilage Grafting.

Tanzer group IIB-constricted ear is described as a deformity of the helix, antihelix, or scapha. Deficiency of the auricular skin and cartilage is a key point in the reconstruction of the cartilaginous framework. Traditionally, the treatment of a constricted ear mainly includes 2 aspects: correction of cartilage deformity and restoration of skin volume deficiency. By mimicking the suspension principle of a cable bridge, our technique only requires adjustment of the spatial directions and mechanical forces between the 2 flaps to achieve an aesthetic effect. The authors were able to avoid harvesting the costal cartilage. The desired ear shape was obtained immediately postoperatively. Therefore, Vaseline gauze was not applied and was modeled along the scapha and antihelix. Expansion of the ear was remarkable in both horizontal and vertical lengths. Our technique causes less damage, less scarring, shorter operation time, fewer complications, faster rehabilitation, and no delays.

An Innovative Stent Consisting of Expanded Polytetrafluoroethylene and Ear Cartilage in Rhinoplasty For Asians: Application I of Dai's Exogenous Extension Stent Concept.

BACKGROUND: Restricted ventilation is common after rhinoplasty with an endogenous extension stent. The authors proposed an exogenous extension stent concept for Asian rhinoplasty patients to avoid this problem. Herein, we introduce an innovative stent in rhinoplasty for Asians, which is an application of this concept. METHODS: An L-shaped expanded polytetrafluoroethylene is hand-carved, and the long arm is placed at the nose back to improve the flatness of the nose, while the short arm supports the nasal column to raise the nose tip. The prosthesis does not occupy nasal volume and therefore theoretically does not affect nasal ventilation. The fan-shaped ear cartilage was placed at the nasal tip to prevent visualization of the nasal tip. The safety and effectiveness of this method were verified through 20 years of clinical practice. The difficulty of learning and popularizing the method was tested through the course of rhinoplasty among 22 plastic surgeons. RESULTS: After 20 years of clinical practice, it was found that this stent could not only effectively improve the nasal dorsum and tip morphology, but also did not actually affect the nasal volume and thus did not affect the nasal ventilation of patients. Among the trainees in plastic surgery, we found that it was not difficult to learn this method of rhinoplasty and the trainees could complete the prosthesis carving well after standardized training. CONCLUSION: This stent consisting of expanded polytetrafluoroethylene and ear cartilage is suitable in rhinoplasty for Asians with significant advantages, one of which is that it has no risk of resulting in restricted nasal ventilation. LEVEL OF EVIDENCE: Level IV.

Application of Auricular Cartilage Scaffold Combined With L-Shaped Prosthesis in Asian Rhinoplasty.

Rhinoplasty is a common surgical procedure in medical cosmetology. From patients with saddle nose deformity to beauty seekers with low and short noses, this surgery is mainly sought to improve the nose's appearance. To investigate the effect of modified auricular cartilage scaffold combined with L-shaped prosthesis in rhinoplasty. This retrospective study included 54 patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped implants in our hospital from July 2018 to July 2021. The function of nasal ventilation and olfaction was inspected. As a result, the degree of nasal tip protrusion and the changes in the superior lip angle of columella were improved. The patients' satisfaction was measured a year after the surgery. Patients who underwent auricular cartilage augmentation rhinoplasty with L-shaped prosthesis were satisfied with the surgery outcomes. Using a protective auricular cartilage scaffold combined with an L-shaped implant for augmentation rhinoplasty reduced the shortage of the application and reinforced the stability of the auricular cartilage augmentation rhinoplasty. At >12 months follow-up, there were no serious adverse effects on nasal ventilation and olfactory function in any of the patients. The presented method made full use of auricular cartilage so that it reduced the harvest of the cartilage. Besides, it achieved the remarkable lift of the nose tip, thus simulating the appearance of costal cartilage rhinoplasty. Furthermore, the risk of implant exposure was efficiently reduced, making it worthy of clinical application.

Nasal Tip Remodeling Using Autologous Cartilage Grafts: Systematic Review.

OBJECTIVE: The objective of this study was to perform a systematic review of the literature to assess the clinical outcomes and safety profile of autologous cartilage grafts (A-CGs) in nasal tip remodeling (NTR). METHODS: The protocol was developed following the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. A multistep search of the PubMed, MEDLINE, Embase, Scopus database, and Cochrane databases has been performed to identify papers on A-CGs use in NTR. Of the 253 articles initially identified, only 39 articles providing either retrospective (n = 35) or prospective (n = 4) data about outcomes, descriptions, and complications of the A-CGs use in NTR were selected. Of these, 3 articles focused on alloplastic grafts were excluded. RESULTS: The nasal septum, concha, and ribs have been the main donor sites to build A-CGs to be used in NTR. Septal cartilage turned out to a specific and versatile, useful for many types of grafts tools, presenting a low rate of resorption, extrusion, and warping. Auricular concha cartilage has been used to correct both the internal and external nasal valve collapse, whereas rib chondral grafts have been used to improve the structural support when septal cartilage was not available. Crushed cartilage, minced cartilage, and diced cartilage have been used in noses with thinner soft tissues. CONCLUSIONS: Eighty percent of the analyzed studies focused on the description of the adopted surgical technique and A-CGs procedures of preparation, displaying encouraging aesthetic and functional outcomes with generally low levels of complications. Collected data confirmed the safety and efficacy of A-CGs-related interventions in NTR without major side effects.

A Two-Stage Training Program for Auricular Framework Fabrication Practicing Using Three-Dimensional Printing Silicone Ribs and Porcine Costal Cartilage.

BACKGROUND: The manufacture of cartilage framework is a key element in the success of total ear reconstruction. Appropriate training can improve cartilage curving and fabricating skills, which is especially helpful for the novice clinicians. Based on threedimensional printing silicone model and porcine rib cartilage, the authors have designed a 2-stage training program to improve skills and cosmetic cognition for ear reconstruction. METHODS: The training program includes 2 successive stages. In the first stage, trainees completed observation of framework fabrication, design and sculpturing practice on silicone rib models. Porcine costal cartilages are used for fabrication in the second stage. After that, the framework was put in a latex glove connected with a suction to simulate the skin cover procedure in operation. RESULTS: At the end of the training program, all trainees could fabricate an ear-shaped cartilage framework successfully. Their cosmetic cognitions of the ear have also improved. CONCLUSIONS: Based on three-dimensional printing silicone model and porcine rib cartilage, the authors have designed a 2-stage training program to improve trainee's carving techniques and cosmetic cognition for ear reconstruction. The authors believe that this training program is helpful in training, practicing and teaching activities of framework fabrication in total ear reconstruction.

Three-Dimensional Auricular Subunit Models for Cartilage Framework Fabrication: Our Preliminary Experience.

BACKGROUND: Three-dimensional (3D) digital imaging and printing techniques have been popularly applied in microtia reconstruction. However, there is a lack of clinical report of using them to create 3D printed ear subunit models for cartilage framework fabrication. METHODS: A retrospective study of patients who underwent auricle reconstruction with 3D templates was performed. Patients' demography, surgical complications, framework accuracy, and aesthetic outcomes of the reconstructed auricles were analyzed. RESULTS: Twenty cases included in this study. Complications were minor. The average (median) assessing scores for the framework quality and the reconstructed auricle aesthetics were 8.50 (8) and 8.30 (8), respectively. CONCLUSIONS: Our study found that the use of custom-printed tridimensional ear subunit models achieved a relatively high framework precision and gained good outcomes of the reconstructed ears.Level of Evidence: Level IV.

Use of Thermoplastic Splint for the Treatment of Auricular Hematoma.

Auricular hematoma is commonly seen in ear nose and throat clinical practice and mostly caused by blunt trauma as a result of traffic accident, wrestling, boxing etc. If hematoma does not discharge, blood supply of the cartilage fails and this results with the necrosis of the auricular cartilage. Incision and drainage of the hematoma is the cornerstone of the surgical treatment and simple compression methods are limited in terms of their ability to eliminate the empty space. Various techniques have been described for the elimination of the death space such as; dental rolls, cotton bolsters, buttons, silastic sheets, etc but compression materials may be insufficient to apply this pressure because of irregular shape of auricle. Resolving these problems, the authors have used thermoplastic splint as a compressive material at 7 patients for elimination of the death space in auricular hematoma treatment.

Otoplasty Outcomes With Different Suture Materials in a Rabbit Model.

Otoplasty is a commonly performed procedure to correct prominent ears. Many different otoplasty techniques have been described but there is no gold standard technique. As well, many different suture materials are used in otoplasty but studies directly comparing different sutures materials are lacking. An otoplasty outcome study with Nylon and Mersilene (2 of the most commonly used sutures in otoplasty) sutures was conducted using a rabbit model. Each rabbit ear was randomized to receive a Mustardé-type horizontal mattress suture with either 4-0 clear Nylon (N = 12 ears) or 4-0 Mersilene sutures (N = 12 ears). Two weeks after surgery, the auricular bend angle was measured with a finger goniometer and histologic analysis with hematoxylin and eosin staining was performed on the rabbit auricular cartilage. Overall, there was no significant difference in the mean bend angle between the 2 groups (Nylon: 135.8°, SD = 22.7° and Mersilene: 143.2°, SD = 19.7°; P = 0.559). Also, no qualitative difference was observed on histologic analysis between the 2 suture groups. In the current rabbit model study, both Nylon and Mersilene sutures performed well and no significant differences were noted.

Ovine model for auricular reconstruction: porous polyethylene implants.

OBJECTIVES: We developed a large animal model for auricular reconstruction with engineered cartilage frameworks and evaluated the performance of porous polyethylene auricular implants in this model. METHODS: Eighteen high-density porous polyethylene auricular frameworks were implanted subcutaneously in the infra-auricular areas of 9 sheep. The implants were harvested 17 weeks later for gross and histologic examination. The perioperative and postoperative courses were carefully documented. RESULTS: Five implants became exposed, and 2 implants needed to be removed at 7 weeks. Additionally, 1 infected implant was removed at 2 weeks. Seromas developed in 2 implants because of drain failures and were drained successfully during the first postoperative week. There were no other surgical site complications. The remaining 10 implants had an acceptable cosmetic appearance at 17 weeks. CONCLUSIONS: The perioperative complication rate in the ovine porous polyethylene auricular implant model was higher than that reported for auricular reconstructions in humans. The implant exposures were likely caused by ischemia and excessive stress on the thin overlying skin, because vascularized flap coverage was not used. The histologic findings were comparable to the results reported for other animal models. This large animal model is appropriate for auricular reconstruction experiments, including engineered constructs.

Two new polymers as candidates for rhinoplasty allografts: an experimental study in a rabbit model.

OBJECTIVES: This study was performed to evaluate the biocompatibility and tensile strength of two new polymeric materials--a polyfluoro ether-modified thermoplastic polyurethane urea and a polydimethyl silicone elastomer--in an experimental rabbit model. METHODS: The two polymers were implanted inside separate subperichondrial pockets created over the auricular cartilages of 12 rabbits. A control pocket received no implant. After 3 months, the animals were painlessly sacrificed, and each site was analyzed histologically for vascular congestion, acute and chronic inflammation, and fibrosis in the tissue surrounding the implant materials. RESULTS: There were no statistically significant differences in vascular congestion, fibrosis, or acute or chronic inflammation between the control sites and either implant site. CONCLUSIONS: These results suggest that the polymers are well accepted by the tissue and remain stable during the entire study period, and that they could be very suitable materials for use in nasal reconstruction.

Structure and Mechanical Performance of Biomimetic Costal Cartilage Models for Ear Framework Handcrafting Simulation.

SUMMARY: Ear framework handcrafting simulation using costal cartilage models is crucially important for ear reconstruction surgery education. Fabrication of proper models that are mechanically and structurally comparable to their native counterparts is an unmet challenge. The authors developed structure and mechanical performance biomimetic costal cartilage models for practicing and simulating handcrafting of ear frameworks. High-tensile silicone and three-dimensional techniques were used to fabricate biomimetic models. The models well-replicated the three-dimensional structure of human costal cartilage. Comprehensive mechanical tests showed that high-tensile silicone models had stiffness, hardness, and suture retention ability similar to those of their native counterparts, and they were distinctly superior to commonly used materials for costal cartilage simulation. This model satisfied surgeons and contributed to creation of outstanding ear frameworks. The recreated models were used in ear framework handcrafting workshops. Novices' surgical simulation performance with different models was compared and analyzed. People who used high-tensile silicone models have greater progress and confidence after training. Using high-tensile silicone costal cartilage models is an excellent choice for practicing and simulating the fabrication of ear frameworks manually. The models benefit practitioners and students in practicing handcrafting ear frameworks and surgical skills.

Total rebuilding of the ear after unsatisfactory initial microtia reconstruction: 30-year experience using autogenous costal cartilage framework.

BACKGROUND: This study describes the author's experience with long-term follow-up analysis of secondary procedures in patients with unsatisfactory initial microtia reconstruction. METHODS: A total of 134 patients who underwent secondary operations between 1992 and 2021 were reviewed by examining medical records and photographic data. A total of 110 patients followed between 6 months and 26 years (average 33.2 months) were included for evaluation of aesthetic outcomes. RESULTS: Primary reconstruction was performed with costal cartilage in 113 patients, porous polyethylene implant in 7 patients, silicone implant in 6 patients, and others in 8 patients. The major external features at the time of the secondary reconstruction were lump (91 cases), deficient convolution (19 cases), and no framework with scarred mastoid skin (22 cases). All secondary reconstructions were performed with an autogenous costal cartilage framework. The framework was covered using temporoparietal fascia flap techniques in 118 patients, mastoid skin coverage technique in 12 patients, and others in 4 patients. One major complication (exposure of cartilage framework due to partial necrosis of fascial flap) and three minor complications (loss of moderate-sized full-thickness skin, grafted on the fascia) were recorded. The average score given for aesthetic outcomes, rated on a four-point Likert scale (i.e., 1 = poor, 2 = fair, 3 = good, and 4 = excellent) was 3.17 (median 3.00). A total of 42% of the patients were rated excellent and 36% were rated good.

Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects.

The external ear is a vulnerable appendage susceptible to trauma. Repairing and recreating its intricate architecture presents a formidable challenge after burn injury, especially when scar tissue, impaired vasculature, and damage to cartilage all influence reconstructive options. The authors share their institutional experience and provide a guide for reconstruction of significant postburn auricular cartilage defects. A retrospective review was conducted on 54 patients (61 ears) aged 0-21 years old admitted to a specialized pediatric burn hospital between January 2004 and January 2021 for postburn ear cartilage reconstruction. Conchal cartilage grafting was performed in 9 patients (9 ears) with an average age of 14.0 ± 5.1 years, requiring an average of 2.0 ± 1.0 procedures that resulted in one case of infection. A total of 21 patients (24 ears) with an average age of 15.1 ± 4.5 years underwent a conchal transposition flap, requiring an average of 1.8 ± 0.4 procedures that resulted in no major complications. A total of 20 patients (23 ears) with an average age of 12.0 ± 5.3 years underwent porous polyethylene implantation, requiring an average of 3.5 ± 1.5 operations that resulted in 3 complications. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13.2 ± 5.3 years, requiring an average of 3.2 ± 2.2 operations that resulted in one case of infection. Postburn ear cartilage defects necessitate an individualized approach tailored to a patient's reconstructive goals. In addition to defect size and location, factors such as reconstructive course duration, complication potential, and anticipated aesthetic results should be discussed with the patient.

Merocel semicompressive dressing to prevent donor-site hematoma on the conchal cartilage graft.

Conchal cartilage grafts are commonly used in rhinoplasties; however, complications related to the donor site, including delayed wound healing and scar formation and hematoma formation, still occur. Hematoma formation is the most important and frequent complication. Conventional tie-over dressing with a bolster has been commonly used to prevent donor-site hematomas, but it does not always give satisfactory outcomes. Therefore, we have introduced a new compressive dressing technique using Merocel, which is cut in half transversely: 1 piece is used as a posterior bolster and the other piece is cut in half again (yielding 2 small pieces) to make a concavity in the conchal cartilage (one piece for cymba concha and the other piece for cavum concha, respectively). After application of Merocel, the overall complication and hematoma formation rates were significantly decreased. Our new compressive dressing technique using Merocel has several advantages. Merocel can absorb more secretions and discharge from the operative site than conventional dressings and there are no risks of tissue necrosis or ischemia due to suture tension. Also, because Merocel can be freely cut and molded and applies even pressure, it can be used on irregular surfaces. Our new compressive dressing technique using Merocel is a simple and reliable option for preventing auricular hematomas.

Avoiding complications of microtia and otoplasty.

Congenital ear surgery constitutes one of the most challenging reconstructive procedures in plastic surgery secondary to the complex architecture of the auricle and the multiple factors involved in the reconstructive techniques. The most common complications encountered during microtia repair and otoplasty are described. Emphasis is placed on preventing these complications.

Hybrid Three-Dimensional-Printed Ear Tissue Scaffold With Autologous Cartilage Mitigates Soft Tissue Complications.

OBJECTIVES/HYPOTHESIS: To analyze the use of highly translatable three-dimensional (3D)-printed auricular scaffolds with and without novel cartilage tissue inserts in a rodent model. STUDY DESIGN: Preclinical rodent animal model. METHODS: This prospective study assessed a single-stage 3D-printed auricular bioscaffold with or without porcine cartilage tissue inserts in an athymic rodent model. Digital Imaging and Communications in Medicine computed tomography images of a human auricle were segmented to create an external anatomic envelope filled with orthogonally interconnected spherical pores. Scaffolds with and without tissue inset sites were 3D printed by laser sintering bioresorbable polycaprolactone, then implanted subcutaneously in five rats for each group. RESULTS: Ten athymic rats were studied to a goal of 24 weeks postoperatively. Precise anatomic similarity and scaffold integrity were maintained in both scaffold conditions throughout experimentation with grossly visible tissue ingrowth and angiogenesis upon explantation. Cartilage-seeded scaffolds had relatively lower rates of nonsurgical site complications compared to unseeded scaffolds with relatively increased surgical site ulceration, though neither met statistical significance. Histology revealed robust soft tissue infiltration and vascularization in both seeded and unseeded scaffolds, and demonstrated impressive maintenance of viable cartilage in cartilage-seeded scaffolds. Radiology confirmed soft tissue infiltration in all scaffolds, and biomechanical modeling suggested amelioration of stress in scaffolds implanted with cartilage. CONCLUSIONS: A hybrid approach incorporating cartilage insets into 3D-printed bioscaffolds suggests enhanced clinical and histological outcomes. These data demonstrate the potential to integrate point-of-care tissue engineering techniques into 3D printing to generate alternatives to current reconstructive surgery techniques and avoid the demands of traditional tissue engineering. LEVEL OF EVIDENCE: NA Laryngoscope, 131:1008-1015, 2021.

The polymethylmethacrylate effects on auricle conchal cartilage: report of 21 cases.

BACKGROUND: Both surgical and nonsurgical techniques, including soft tissue augmentation, are available to restore a youthful appearance to the face. Soft tissue augmentation with nonabsorbable fillers is increasingly important, as a growing number of patients are seeking aesthetic improvement without the downtime and cost of major surgical procedures. Polymethylmethacrylate (PMMA), an injectable implant composed of a suspension of microspheres in different media, is one such soft tissue filler. OBJECTIVES: Because the application of PMMA into the pericartilage of the ear is becoming a more common practice among plastic surgeons, the authors offer a systematic analysis of its effects. They believe this information to be of paramount importance to prevent injuries and deformities. METHODS: Twenty-one patients who presented to the lead author's clinic with prominent ears during a period of 16 months between 2007 and 2008 were retrospectively reviewed. The authors analyzed PMMA's effects on each patient's ear shell cartilage, which was extracted during correction without causing any kind of injury or deformity to the participants in this study. RESULTS: The histopathologic study from the excised skin and cartilage samples showed a granulomatous inflammation in all patients. There was no association between the incidence of tissue alterations and the mean length of PMMA on the conchal cartilage. CONCLUSIONS: The potential consequences of PMMA injection in close proximity to cartilage cannot be predicted and the possibility of myxomatous cartilage degeneration is a serious potential adverse event because it can cause permanent deformities of the cartilaginous skeleton.

Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap.

Ear reconstruction is a difficult procedure requiring a framework and soft tissue covering. The traditional method uses a rib cartilage framework placed beneath scalp skin. This method has been used for 50 years despite inherent problems with both harvesting rib cartilage and using scalp for coverage. The authors describe a method using a porous polyethylene (PPE) framework covered by a large temporoparietal fascia (TFP) flap raised with the underlying subgaleal fascia (SGF). The entire implant is covered by the two-layered flap, which can be raised without any scalp incision. The skin grafts applied to the covered implant lie on the SGF. The trilaminar structure of the SGF allows the skin to move independently over the implant, resisting shear forces and reducing the probability of implant exposure. Ear reconstruction using the PPE framework was performed on 786 ears over an 18-year period. Initial complications were common. With improved implant design and complete coverage of the implant with both the TPF and SGF, exposure rate dropped to 7% with a 12-year follow-up. Implant fractures decreased to less than 3%. The PPE/TPF method allows earlier ear reconstruction in children with minimal scarring and discomfort. The reconstructed ear can closely mimic the shape and projection of the natural contralateral ear in fewer stages and with a shorter learning curve.

Effect of different suture materials on cartilage reshaping.

BACKGROUND: Suturing techniques are one of the most commonly used means to reshape the nasal cartilage; however, no data exist regarding the optimal suture material and its long-term effect. OBJECTIVES: The aim of the present study was to determine whether any absorbable materials will provide the same long-lasting effect on cartilage reshaping as permanent materials. METHODS: Thirty-six New Zealand white rabbits were divided into three groups of 12. A 3 mm x 4 mm cartilaginous fold was created on a 5 mm x 10 mm in situ strip of cartilage on the posteromedial surface of each ear with different suture materials to simulate transdomal sutures. Nylon was used as a control suture material on the right ear of every rabbit, while plain catgut, monocryl, or polydioxanone (PDS) was used on the left ear, depending on the study group. At the end of 3 months, the folds were harvested and their dimensions and histology were compared. RESULTS: The cartilaginous folds were graded on a scale of 1 to 4 based on the final fold height measurement. The mean grades were 3.51 for nylon, 3.50 for PDS, 2.08 for monocryl, and 1.83 for plain catgut. Nylon provided a significantly better fold grade compared to monocryl and plain catgut (P < .05 for both groups), whereas there was no difference between the fold created with nylon and PDS (P > .05). Among the pathologic factors examined, only the amount of adipose tissue between the fold correlates with a higher fold grade (P < .05). CONCLUSIONS: Cartilaginous folds created using PDS are comparable to those created using nylon and are significantly better than monocryl and plain catgut materials. On this animal model, it appears that permanent suture material is not required to maintain a long lasting cartilaginous fold as long as the suture material holds the fold in shape for a certain period of time.