Adam Bryce Weinfeld, MD Austin, Texas Advanced Cosmetic Surgery - - PowerPoint PPT Presentation

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Adam Bryce Weinfeld, MD Austin, Texas Advanced Cosmetic Surgery - - PowerPoint PPT Presentation

Oct 25, 2023 317 likes •777 views

Adam Bryce Weinfeld, MD Austin, Texas Advanced Cosmetic Surgery Advanced Surgery of the Nose austinfaceandnose.com Technique for Complex Rhinoplasty: The Weck Blade Facilitate the Carving of Costal Cartilage Grafts Mission: Repurpose

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Adam Bryce Weinfeld, MD

Austin, Texas Advanced Cosmetic Surgery Advanced Surgery of the Nose austinfaceandnose.com

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Technique for Complex Rhinoplasty: The Weck Blade Facilitate the Carving of Costal Cartilage Grafts

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Mission: Repurpose Forgotten Blades

Adam Bryce Weinfeld, MD

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All Rhinoplasty is Complex

Complex Rhinoplasty Defined - requires extra- nasal cartilage grafts to achieve goals due to the absence of sufficient septal cartilage

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Insufficient Septal Cartilage

  • Prior isolated septoplasty
  • Secondary rhinoplasty
  • H/O significant septal trauma
  • Some cleft rhinoplasty/congenital deformities
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Context: Weck Blade Use

  • Carving rhinoplasty cartilage grafts from costal

cartilage for complex rhinoplasty

  • Use it for all graft carving (spetal/conchal)

when long straight cut required

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Thesis Statement

  • The weck blade facilitate the carving of costal

cartilage grafts

– Used without guard

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Inherent Qualities of Weck Blade

  • Thin
  • Long
  • Straight edge
  • Recessed handle
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Inherent Qualities of Traditional Alternatives (10,11,15,20)

  • Thicker
  • Shorter
  • Rounded cutting surface (except 11)
  • Inline handle
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Comparison of Action

Weck

  • Chop/Chop slice (str/lng)
  • Simultaneous graft cut (lng)
  • Better hand position (RH)
  • True cut (thin)

10,11,15,20

  • Slice/Drag (rnd/short)
  • Sequential cut (rnd/short)
  • Awkward hand position (IH)
  • Cut/split (thicker)
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Benefits

  • Precision in cutting long thin grafts that are

straight with parallel cuts

– Spreader, lateral crus, columellar strut, alar rim

  • Chopping/Mincing

– Turkish Delight and variations

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Series

  • 49 Rhinoplasties
  • 21 costal cartilage grafts
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Patients/Indications

  • 12 adults

– 1 secondary cleft – Remainder: secondary rhino > post-septo

  • 9 adolescents

– 7 cleft – 2 post-speto

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Costal Grafts

  • Spreader & alar rim – all
  • Columellar strut – 15 (12 with non-anchored

threaded k-wire core)

  • Lateral crus graft – 17 (either uni or bi)
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Thin Slices

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Columellar Strut: Close to Wire

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Clarification

  • Columellar strut with k-wire: non-anchored

core-only threaded wire to prevent warping

– Core-only = no exposed wire

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Costal-Sourced Extra-Anatomic

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Costal Spreader Grafts

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Costal Lat. Crural Grafts

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Full Set

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Complex Rhino with Costal Cart (Prior Septoplasty)

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Complex Post Traumatic Rhino with Costal Cart

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Of Interest: Post Lefort I (Patrick Kelley, MD)

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Complex Secondary Rhino With Costal Cart

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Complex Cleft Rhino (2nd) with Costal Cart

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Tertiary Rhinoplasty with Costal Cart.

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Adam Bryce Weinfeld, MD

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Secondary Cleft

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Complications

  • None directly attributable to Weck blade
  • Infection - 1
  • Revisions - 2 cleft patients
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Summary

  • Facilitates carving of long thin grafts

– mm at a time all at once

  • Symmetric
  • Straight edges
  • Precision

– LLC – Columellar strut

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Submitted for Publication

  • Aesthetic Surgery Journal
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Thank You

Adam Bryce Weinfeld, MD austinfaceandnose.com