{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:49:52Z","timestamp":1777643392437,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JAMA Facial Plast Surg"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Composite grafting in nasal reconstruction involves transplanting auricular chondrocutaneous grafts, but the optimal design of these grafts is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the ideal ratio of skin to cartilage as well as study the importance of the perichondrial attachment for graft survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>A New England white rabbit model was used in this study, performed at the Laboratory for Animal Research at University of Kansas Medical Center from January 25 to March 18, 2016. Four varying designs of chondrocutaneous auricular grafts were transplanted to dorsal back defects, with a total of 10 grafts per treatment arm completed. The following 4 chondrocutaneous circular grafts were designed: group A, 1.5-cm diameter graft of equal skin to cartilage ratio; group B, 2.0-cm diameter skin and 1.5-cm diameter cartilage; group C, 1.5-cm diameter skin and 2.0-cm diameter cartilage; and group D, 1.5-cm diameter skin and cartilage separated and placed back together in a layered fashion. Grafts were observed until postoperative day 21, harvested, and evaluated with visual observation as well as histopathologic assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Visually graded areas of survival were marked by 2 blinded academic facial plastic surgeons and calculated for approximate survival. Hematoxylin-eosin\u2013stained, paraffin-embedded 5-\u03bcm slides were evaluated for overall survival rate, rate of cartilage necrosis, and mean vessel density per high-power field. In both cases, observers were blinded as to the study group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Visual assessments of the 5 female rabbits showed significant agreement between surgeons and consistency, with a Spearman coefficient of 0.84 and an intraclass correlation of 0.98. Group D (skin and cartilage separation) was visually graded to have significantly decreased mean survival (45.4%; 95% CI, 23.3%-67.4%) compared with group A (mean survival, 97.4%; 95% CI, 94.8%-99.9%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), group B (mean survival, 87.6%; 95% CI, 69.9%-100%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004), and group C (mean survival, 82.1%; 95% CI, 66.0%-98.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.008). Histopathologic assessment revealed that group D again showed significantly inferior overall survival, increased cartilage necrosis, and decreased mean vessel density compared with group A. Group C additionally showed significantly decreased cartilage survival compared with group A (65% vs 0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and group B (65% vs 35%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>These results represent preliminary evidence that the attachment of skin to perichondrium in a composite graft plays an important role for graft survival. Clinicians performing nasal reconstruction with chondrocutaneous composite grafts should consider preserving attachments at this junction to improve graft survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/jamanetwork.com\/journals\/jamafacialplasticsurgery\/pages\/instructions-for-authors\/#SecLevelofEvidence\/Ethnicity\">NA<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamafacial.2018.1044","type":"journal-article","created":{"date-parts":[[2018,9,29]],"date-time":"2018-09-29T03:43:39Z","timestamp":1538192619000},"page":"44-49","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of Skin and Cartilage Variables With Composite Graft Healing in a Rabbit Model"],"prefix":"10.1177","volume":"21","author":[{"given":"G. Nina","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ossama","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Surgical Pathology Fellowship Program, Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Sykes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. David","family":"Kriet","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Kansas Medical Center, Kansas City"},{"name":"Division of Facial Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dianne","family":"Durham","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clinton D.","family":"Humphrey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Kansas Medical Center, Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,1,17]]},"reference":[{"key":"e_1_3_1_2_2","first-page":"137","article-title":"On filling defects of the nostril wall","volume":"39","author":"K\u00f6nig F","year":"1902","unstructured":"K\u00f6nig F. On filling defects of the nostril wall. Berl Klin Wochenschr. 1902; 39:137.","journal-title":"Berl Klin Wochenschr"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.2258"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-196006000-00002"},{"issue":"6","key":"e_1_3_1_5_2","doi-asserted-by":"crossref","first-page":"647","DOI":"10.5999\/aps.2014.41.6.647","article-title":"The effect of platelet-rich plasma on survival of the composite graft and the proper time of injection in a rabbit ear composite graft model","volume":"41","author":"Choi HN","year":"2014","unstructured":"Choi HN, , Han YS, , Kim SR, , Kim HK, , Kim H, , Park JH. The effect of platelet-rich plasma on survival of the composite graft and the proper time of injection in a rabbit ear composite graft model. Arch Plast Surg. 2014; 41(6):647-653. doi:10.5999\/aps.2014.41.6.647, 25396175","journal-title":"Arch Plast Surg"},{"issue":"3","key":"e_1_3_1_6_2","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1001\/archotol.1993.01880150069010","article-title":"Pharmacologic and surgical enhancement of composite graft survival","volume":"119","author":"Fann PC","year":"1993","unstructured":"Fann PC, , Hartman DF, , Goode RL. Pharmacologic and surgical enhancement of composite graft survival. Arch Otolaryngol Head Neck Surg. 1993; 119(3):313-319. doi:10.1001\/archotol.1993.01880150069010, 8435171","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.8.5.310"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2014.01.001"},{"issue":"2","key":"e_1_3_1_9_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/00005537-200302000-00010","article-title":"Healing of composite chondrocutaneous auricular grafts covered by skin flaps in nasal reconstructive surgery","volume":"113","author":"Keck T","year":"2003","unstructured":"Keck T, , Lindemann J, , K\u00fchnemann S, , Sigg O. Healing of composite chondrocutaneous auricular grafts covered by skin flaps in nasal reconstructive surgery. Laryngoscope. 2003; 113(2):248-253. doi:10.1097\/00005537-200302000-00010, 12567077","journal-title":"Laryngoscope"},{"issue":"3","key":"e_1_3_1_10_2","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/SCS.0b013e31820f7fde","article-title":"Use of outsized composite chondrocutaneous grafts in conjunction with dermal turnover flaps for reconstruction of full-thickness alar defects","volume":"22","author":"Pilanci \u00d6","year":"2011","unstructured":"Pilanci \u00d6, , Sa\u00e7ak B, , Kuvat SV, , \u015een E, , Arslan H, , Aygit AC. Use of outsized composite chondrocutaneous grafts in conjunction with dermal turnover flaps for reconstruction of full-thickness alar defects. J Craniofac Surg. 2011; 22(3):864-867. doi:10.1097\/SCS.0b013e31820f7fde, 21558924","journal-title":"J Craniofac Surg"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-1226(03)00004-3"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1275773"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e3180f62b36"},{"issue":"1","key":"e_1_3_1_14_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s12070-015-0935-3","article-title":"Study of outcome of an implanted autologous auricular cartilage: a preliminary experimental research in rabbits","volume":"68","author":"Belaldavar BP","year":"2016","unstructured":"Belaldavar BP, , Mudhol RS, , Dhorigol V, et al. Study of outcome of an implanted autologous auricular cartilage: a preliminary experimental research in rabbits. Indian J Otolaryngol Head Neck Surg. 2016; 68(1):11-15. doi:10.1007\/s12070-015-0935-3, 27066402","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"e_1_3_1_15_2","first-page":"339","volume-title":"Local Flaps in Facial Reconstruction","author":"Jewett BS","year":"2014","unstructured":"Jewett BS. Skin and composite grafts. In: Baker S, ed. Local Flaps in Facial Reconstruction. 3rd ed. Elsevier; 2014:339-367.","edition":"3"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2013.25"},{"issue":"7","key":"e_1_3_1_17_2","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1111\/j.1524-4725.2010.01602.x","article-title":"The placement of structural cartilage grafts under full-thickness skin grafts: a case series and strategies for successful outcomes","volume":"36","author":"Barlow JO","year":"2010","unstructured":"Barlow JO. The placement of structural cartilage grafts under full-thickness skin grafts: a case series and strategies for successful outcomes. Dermatol Surg. 2010; 36(7):1166-1170. doi:10.1111\/j.1524-4725.2010.01602.x, 20533936","journal-title":"Dermatol Surg"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000138817.14320.EC"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.20982\/tqmp.08.1.p023"}],"container-title":["JAMA Facial Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1001\/jamafacial.2018.1044","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/jamafacial.2018.1044","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/jamafacial.2018.1044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:26:00Z","timestamp":1777443960000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1001\/jamafacial.2018.1044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1001\/jamafacial.2018.1044"],"URL":"https:\/\/doi.org\/10.1001\/jamafacial.2018.1044","relation":{},"ISSN":["2168-6076","2168-6092"],"issn-type":[{"value":"2168-6076","type":"print"},{"value":"2168-6092","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}