Harvest of rib cartilage graft for use in pediatric laryngotracheal reconstruction

When an anterior or posterior cartilage graft is needed to reconstruct a pediatric airway with subglottic stenosis. This is a much more robust cartilage graft compared to thyroid ala, septal, or auricular cartilage as these do not typically provide enough structural support.

The harvest of this graft must be performed in a sterile environment with separate surgical equipment used instead of using the same equipment that was used for the neck to avoid cross-contamination

See laryngotracheal reconstruction video

The incision is typically made in the inframammary crease and dissection taken down to perichondrium of the rib. The costochondral junction is located utilizing a needle. Periosteum is preserved on one side of the graft during the harvest. The length of graft required is pre-determined by measurements of the airway prior to starting the cartilage harvest.

Stronger than auricular, thyroid ala, or septal cartilage, and is thus considered the 'workhorse' cartilage graft for airway reconstruction. Disadvantage is that it requires a separate surgical field and dissection adding to the length of the surgery.

Care must be taken to avoid violating the pleural space during dissection as this could potentially lead to a pneumothorax.

Care must be taken to avoid violating the pleural space during dissection as this could potentially lead to a pneumothorax.