Rib grafts: some advantages
They are easily bent and fixed with wires.
• easily implemented and consolidated
to the host bone.
Important: short incision,no subcutaneous dissection,incise upto rib:wound is irrigated and checked for any air leak and bleeding.
***The targeted rib is identified and the deep
thoracic fascia is incised with an electrocautery.
• Subfascial exposure of the rib.
• Longitudinal incision of the periosteum
along its lateral surface.
• Subperiosteal elevation along the edges
of the rib with an angled square elevator
and then on the medial aspect for a few
• Medial dissection is continued posteriorly
by means of a Doyen semicircular
elevator for 5 cm and then anteriorly
up to the costochondral junction.
• Divide the rib close to the costochondral
junction with an angled Liston
• Grasp the rib with an angled flexible
bone holder and then continue the subperiosteal
dissection posteriorly with a
set of Semb elevators; first, along the
lateral aspect, then on the edges, and
finally on the medial aspect in an alternating
***technique: FIG. Stripping periosteum from lateral surface of the rib; (center) passing the Doyen elevator behind the rib; (right)
cutting dissected rib with the costotome.
important: Preserve the integrity of the parietal pleura with proper use of the Semb periosteal
FIG. Instruments for taking ribs. A and B, Long rib
retractors; C and D, periosteal elevators; E and F, Farabeuf
retractors; G and H, Semb dissectors.
FIG. More instruments for taking ribs. A and B, Long
costotomes; C, strong bone cutter; D, bone-contouring forceps;
E and F, bone-holding forceps; G and H, 10- and 15-mm
straight, sharp osteotomes.
***ref: P. Tessier, M.D., H. Kawamoto, M.D., D. Matthews, M.D., J., Posnick M.D., Y. Raulo, M.D.,
J. F. Tulasne, M.D., and S. A. Wolfe, M.D.
Miami, Fla., Taking long rib grafts for facial reconstruction,Vol. 116, No. 5 October Supplement 2005 /