Autologous cartilage grafts enhanced by a novel transplant medium using fibrin sealant and fibroblast growth factor

Abstract

Objective: To introduce and assess a system for the delivery of fibroblast growth factor to autologous cartilage grafts using fibrin sealant and analyze whether this "enhancement" results in reduced rates of cartilage resorption and greater preservation of normal architectural features compared with "unenhanced" cartilage grafts. Methods: Auricular cartilage segments measuring 1 cm2 were harvested from 12 New Zealand white rabbits, morselized, and implanted into the subcutaneous dorsum of the upper back for 3 months. The conditions included (1) cartilage alone; (2) cartilage+fibrin sealant; (3/4) cartilage+acidic or basic fibroblast growth factor (aFGF or bFGF); and (5/6) cartilage+fibrin sealant+aFGF or bFGF. Subsequent to graft harvest, gross and microscopic assessments were performed to assess size, structural integrity, and architectural features, with comparisons performed between each of the conditions. Results: Themean areas of the harvested cartilage grafts treated with fibrin sealant+aFGF or bFGF were 1.23 cm2 and 1.19 cm2, respectively, while the corresponding value for the untreated (ie, cartilage alone) specimens was 1.03 cm2. The percentage of decrease in size was 45% for the untreated specimens and 0% for the specimens treated with fibrin sealant+aFGF or fibrin sealant+bFGF. Cartilage treated with fibrin sealant+bFGF had the greatest quantity of elastin fibers of the 6 conditions. Cartilage grafts treated with fibrin sealant alone demonstrated the most intense ground substance staining on a computerized measure of pixel intensity. Conclusions: Our findings demonstrated significant improvements in graft quality using fibroblast growth factor and fibrin sealant or even fibrin sealant alone. These findings may justify changes in how cartilage grafts are prepared and delivered for facial augmentation procedures to reduce graft resorption and maintain the structural integrity of the cartilage. Further trials will be performed to elucidate the optimal growth factor concentrations for maximum structural and architectural benefits. © 2004 American Medical Association. All rights reserved.