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Efficacy of platelet-rich fibrin matrix on viability of diced cartilage grafts in a rabbit model

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The Laryngoscope

VC 2014 The American Laryngological,

Rhinological and Otological Society, Inc.

Efficacy of Platelet-Rich Fibrin Matrix on Viability of Diced Cartilage

Grafts in a Rabbit Model

_Ismail G€uler, MD, PhD; Deniz Billur, MD, PhD; Sevim Aydin, MD, PhD; Sinan Kocat€urk, MD, PhD

Objectives/Hypothesis: The objective of this study was to compare the viability of cartilage grafts embedded in platelet-rich fibrin matrix (PRFM) wrapped with no material (bare diced cartilage grafts), oxidized methylcellulose (Surgicel), or acellular dermal tissue (AlloDerm).

Study Design: Experimental study.

Methods: In this study, six New Zealand rabbits were used. Cartilage grafts including perichondrium were excised from each ear and diced into 2-mm-by 2-mm pieces. There were four comparison groups: 1) group A, diced cartilage (not wrapped with any material); 2) group B, diced cartilage wrapped with AlloDerm; 3) group C, diced cartilage grafts wrapped with Sur-gicel; and 4) group D, diced cartilage wrapped with PRFM. Four cartilage grafts were implanted under the skin at the back of each rabbit. All rabbits were sacrificed at the end of 10 weeks. The cartilages were stained with hematoxylin-eosin, Masson’s Trichrome, and Orcein. After that, they were evaluated for the viability of chondrocytes, collagen content, fibrillar structure of matrix, and changes in peripheral tissues.

Results: When the viability of chondrocytes, the content of fiber in matrix, and changes in peripheral tissues were com-pared, the cartilage embedded in the PRFM group was statistically significantly higher than in the other groups (P < 0.05).

Conclusion: We concluded that PRFM has significant advantages in ensuring the chondrocyte viability of diced cartilage grafts. It is also biocompatible, with relatively lesser inflammation and fibrosis.

Key Words: Platelet-rich fibrin matrix (PRFM), diced cartilage, rhinoplasty, AlloDerm, Surgicel. Level of Evidence: N/A.

Laryngoscope, 125:E104–E111, 2015

INTRODUCTION

Autologous cartilage grafting is a widely used method in rhinoplasty.1,2However, cartilage grafting has several drawbacks, such as risks of resorption and necro-sis.2–4In order to increase the viability of cartilage tis-sue and prevent its resorption, many techniques have been described. Among these techniques, Erol’s “Turkish delight” method of using diced cartilage grafts wrapped with oxidized methylcellulose (Surgicel; Johnson and Johnson Medical Inc., Arlington, TX) recently has been popular.5In the long term, however, recent clinical stud-ies have reported that the diced cartilage wrapped with Surgicel was easily resorbable and created a limitation in their application.6–8

Some researchers have used temporal muscle fascia with a wrapping method in order to avoid foreign-body reactions in particular, among others. Although the resorption rate and frequency of related foreign-body reactions were much lower than those of Surgicel,9,10

this method has several disadvantages, including donor-site scarring and the need for a second incision. To over-come these disadvantages, a preserved human dermis (AlloDerm; LifeCell Corporation, Branchburg, NJ) was used.11 Unfortunately, the risk of immune reactions, its high price, and difficulty in harvesting graft material have limited the usage.

Many investigations have been performed to extend the survival of autogenous cartilages with a goal to make them ideal implant materials.12 Platelet-rich plasma (PRP) is a plasma fraction that is produced from autologous blood samples containing relatively higher concentration of platelets.13 PRP has several different growth factors and other cytokines that stimulate heal-ing of bone.14,15 It has been used for different purposes in surgery for approximately 30 years and conceivably increases the survival of cartilage grafts used in rhinoplasty.16–18

Platelet-rich fibrin matrix (PRFM) was firstly intro-duced by Choukroun in 200119 and undeniably is easily obtained. In this study, we aimed to compare the viabil-ity of cartilage wrapped with PRFM with the cartilage that was left bare, the cartilage wrapped with Surgicel, and the cartilage wrapped with AlloDerm.

MATERIALS AND METHODS

The experimental design was reviewed and approved (no. 2012-22-134) by the ethics committee in animal experiments at Ankara University, and the study was carried out in compliance with the guidelines for animal experimentation at the

From the Department of Otolaryngology, School of Medicine, Ufuk University (I.G.,S.K.); and the Department of Histology and Embryology, School of Medicine, Ankara University (D.B.,S.A.), Ankara, Turkey

Editor’s Note: This Manuscript was accepted for publication November 20, 2014.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Deniz Billur, MD, Department of Histology and Embryology, School of Medicine, Ankara University, Ankara Turkey. E-mail: denizbillur@gmail.com

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Department of Laboratory Animal Science at Ankara University Medical School (Ankara, Turkey). All animals used for the experiments received care according to the Principles of Labora-tory Animal Care recommended by the National Society of Med-ical Research and the Guide for the Care and Use of Laboratory Animals, proposed and prepared by the National Academy of Sciences and published by the National Institutes of Health (NIH publication No. 85-23, revised 1996).

Animal Care

Animals were housed in a controlled environment at a temperature of 18C 6 1C and with a relative humidity of 50%

to 70%. They were also exposed to 12-hour light–dark cycles and fed with pellets and water ad libitum. All animal care serv-ices and procedures were performed without inflicting pain. A total of six New Zealand rabbits, each weighing approximately 2 kg, were used for the study. Each rabbit was anesthetized with 35 mg/kg ketamine and 5 mg/kg xylazine hydrochloride, both given intramuscularly.

Material Used in the Study 1. Biomaterials.

AlloDerm: Pieces of thin layers of acellular human epidermal tissue with a thickness of 0.89 mm to 1.65 mm and meas-uring 2 cm by 4 cm were used.

PRFM: Using Choukroun’s method, the blood samples from rabbits were harvested and put in 10-cc venous blood tubes without anticoagulant.19 Tubes were centrifuged (N€uve Corporation CN 090, Ankara, Turkey) for 10 minutes at 3,000 rpm (400 g). The absence of anticoagulant implies the activation within a few minutes of most platelets in the blood sample that are in contact with the tube walls, as well as the release of coagulation cascades. Before the circulating thrombin transforms fibrinogen into fibrin, fibrinogen is con-centrated in the upper part of the tube. Afterward, a fibrin clot is obtained in the middle of the tube, just between the red blood cells at the bottom and the acellular plasma at the top.20The samples of platelet-rich fibrin (PRF), which accu-mulated in the middle of the tube after centrifuge, were picked up from the tubes by the help of a pincette and sepa-rated from the red blood cells. PRF was exposed to pressure between the two glass slides. After this process, the PRFM, which had risen between the slides, were cut into 2- by 2-cm pieces using scissors, and then the diced cartilages were wrapped.

2. Nonbiomaterials: Oxidized cellulose polymers in 5.1- by 7.6-cm pieces (Surgicel) were used.

Method

1. Surgical technique. To prepare the recipient site, the back and the right ear of each rabbit was shaved, cleaned, and disinfected with povidone iodine (Betadine Hydrochloride. Purdue Pharma L.P, Stamford, USA.), and 7- to 8-cm inci-sions were made on the dorsal surface of the ear. A by 3-cm (2 cc) auricular cartilage was harvested with its peri-chondrium. Incisions were closed with 4/0 vicryl sutures. Four separate incisions were made on the back of the rab-bits. Then, 3- by 4-cm pockets were made on the back of each rabbit. Afterward, four cartilage grafts were inserted into the four subcutaneous pockets on the same animal. The incisions sutured with 4/0 vicryl sutures. The grafts left at the recipient sites for 10 weeks postoperatively.

2. Graft preparation. In our study, approximately 2 cc of carti-lage was harvested from each ear of the rabbits. The excised cartilage, with its perichondrium, was diced into mm- by 2-mm pieces. Four pieces (each 0.5 cc) of the diced cartilage was wrapped with rehydrated AlloDerm (group B), Surgicel (group C), 2- by 2-cm PRFM (group D), and in the control group it was left bare (group A) (Fig. 1).

3. Implantation of the diced cartilage grafts. Several incisions, each 3 cm to 4 cm in length, were made on the back of each rabbit and the diced cartilage was implanted under the skin. The incisions were marked as diced cartilage (control group A), AlloDerm (group B), Surgicel (group C), and PRFM (group D). The incisions were closed with 4/0 vicryl sutures. 4. Harvesting. After 10 weeks, the implantation sites of the

rabbits were shaved again and the cartilages were harvested from the original incision sites. Specimens were placed into 10% formalin solution for fixation.

Histological Examination and Analysis

After formalin fixation for 72 hours, samples were dehy-drated, cleared, and embedded in paraffin. Tissue sections (4–5 lm) were stained with hematoxylin and eosin (H&E), Masson’s Trichrome, and Orcein. The H&E-stained sections were used to evaluate chondrocyte viability and the status of the chondroid tissue. Masson’s Trichrome demonstrates collagen content of the matrix by staining the collagen fibrils green. Orcein stains elas-tic fibers in the matrix. Each sample was evaluated under light microscope (Carl Zeiss Axio Scope-A1, G€ottingen, Germany) by two histologists with no knowledge of examination groups. They were used a scoring system for evaluation of morphology and histological parameters that modified from Kim et al.21Ten his-tological parameters were reviewed in three groups: 1) loss of chondrocyte nuclei, peripheral proliferation; 2) collagen and Fig. 1. Four types of grafts. (A) diced cartilage; (B) graft wrapped with AlloDerm; (C) graft wrapped with Surgicel; and (D) graft wrapped with PRFM. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

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elastic fiber content of the matrix; and 3) fibrosis, inflammation, vascularization, metaplastic bone formation, fragmentation and chondroid tissue resorption. Quantitative analyses of all param-eters were performed between groups. Parameters were recorded as a percentage of all analyzed material: 0% as none (2), 1% to 25% as minimal (11), 26% to 50% as moderate (21), 51% to 75% as moderate to severe (31), and 76% to 100% as severe (41).

Statistical Analysis

Statistical analyses were performed using the SPSS soft-ware package (version 18.0; Chicago, IL). In intergroup compar-isons, a nonparametric test (Kruskal- Wallis) and Mann-Whitney test were used. The average of each group was calcu-lated. Results were evaluated at a significance level of P < 0.05.

RESULTS

Macroscopic Observation

All harvested grafts showed adhesions. In the con-trol group, the grafts were more irregular than those of the other experimental groups. In all experimental groups, graft unity was observed. The grafts that were wrapped with Surgicel were smaller in volume than those used in the other experimental groups.

Histological Examination

Histopathological parameters reviewed in four groups were demonstrated in Table I.

Group A (Diced Cartilage). H&E-stained prepa-rations demonstrated that the content of chondrocyte nuclei was the indicator of viability (Fig. 2 a,b). In the matrix, we observed that the collagen fibers in the matrix stained green with Masson Trichrome and elastic

fibers stained brown with orcein (Fig. 2 c,d). In the carti-lage matrix, both types of fibers were in minimal amount. We observed minimal fibrosis, inflammation, and vascularization in the tissue around the cartilage. There was no metaplastic bone formation. Minimal carti-lage fragmentation and resorption were noted (Fig. 2a).

Group B (Diced Cartilage Grafts Wrapped With AlloDerm). Whereas the loss of nuclei in the specimens of diced cartilage grafts wrapped with AlloDerm was variable (moderate to severe loss), peripheral prolifera-tion was moderate (Fig. 3 a,b). The presence of collagen and fiber contents was moderate (Fig. 3 c,d). However in fibers around the cartilage tissue, vascularization was minimal, and the level of fibrosis and inflammation increased moderately. Metaplastic bone formation was observed in two rabbits. Cartilage fragmentation was observed in our specimens, whereas the resorption of cartilage grafts was minimal (Fig. 3 a).

Group C (Diced Cartilage Grafts Wrapped With Surgicel). When the specimens of cartilage grafts were wrapped with Surgicel, there was severe loss of nuclei in chondrocytes stained with H&E and minimal peripheral proliferation was seen (Fig. 4 a,b). It was observed that collagen and the content of elastic fiber were minimal (Fig. 4 c,d). Vascularization was minimal, fibrosis was moderate, and the level of inflammation was between moderate and severe in the tissue that surrounds the cartilage. Metaplastic bone formation was observed in one rabbit. The degree of fragmentation and resorption of cartilage grafts was between moderate and severe. (Fig. 4 a,b).

Group D (Diced Cartilage Grafts Wrapped With Plasma-Rich Fibrin Matrix). In the specimens of cartilage grafts wrapped with PRFM, minimal loss of chondrocyte nuclei was observed as compared with the

TABLE I.

Histological Parameters of Groups.

Diced Cartilage

Diced Cartilage With AlloDerm

Diced Cartilage With Surgicel Diced Cartilage With PFRM n 5 6 n 5 6 n 5 6 n 5 6 Histological Parameters 2 11 21 31 41 2 11 21 31 41 2 11 21 31 41 2 11 21 31 41 Cartilage viability

Loss of chondrocyte nucleus 0 1 1 2 2 0 1 1 3 1 0 0 1 3 2 4 1 1 0 0

Peripheral proliferation 0 3 1 1 1 0 4 1 1 0 1 3 2 0 0 0 1 2 2 1

Matrix

Collagen 0 4 2 0 0 0 2 2 2 0 2 3 0 1 0 0 2 1 2 1

Elastic fiber 0 2 4 0 0 0 0 5 1 0 0 3 2 1 0 0 0 2 4 0

Changes of peripheral tissue

Fibrosis 1 3 0 2 0 0 2 2 2 0 0 3 1 1 1 2 3 1 0 0

Inflammation 1 3 2 0 0 0 1 2 2 1 0 1 2 2 1 5 1 0 0 0

Vascularization 1 3 2 0 0 1 4 1 0 0 2 3 1 0 0 0 4 1 1 0

Metaplastic bone formation 6 0 0 0 0 4 1 1 0 0 5 1 0 0 0 5 1 0 0 0

Fragmentation 4 1 1 0 0 2 2 2 0 0 0 1 2 3 0 5 0 0 1 0

Resorption 1 4 0 1 0 4 1 0 1 0 0 1 2 2 1 4 2 0 0 0

(2) 5 none; (11) 5 minimal; (21) 5 moderate; (31) 5 moderate to severe; (41) 5 severe. PFRM 5 platelet-rich fibrin matrix.

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other groups. Additionally, moderate to severe degrees of peripheral proliferation were noted. Analysis of the peripheral tissue demonstrated minimal degrees of fibro-sis and vascularization without any evidence of inflam-mation. Additionally, metaplastic bone formation was seen in only one specimen, and bone fragmentation and resorption was minimal (Fig. 5 a,b). When the content of collagen and elastic fiber was analyzed, it was seen that both types of fibers were preserved moderate and severe degree (Fig. 5 c,d).

Statistical Analysis

When the PRFM group (group D) was compared to the diced cartilage group (group A), there were signifi-cant differences in viability of the cartilage, fibrosis, inflammation, and resorption of the cartilage. When the PRFM group (group D) was compared to the AlloDerm group (group B), there were significant differences in the loss of chondrocytic nuclei, fibrosis, and inflammation. When PRFM group (group D) was compared to the Sur-gicel group (group C), there were significant differences in the loss of chondrocyte nuclei, peripheral prolifera-tion, extent of elastic fiber, inflammaprolifera-tion, fragmentaprolifera-tion, and cartilage resorption (P < 0.05) (Table II). There was no significant difference among the groups regarding

metaplastic bone formation, vascularization, and colla-gen content of the fibers.

DISCUSSION

Cartilage grafts have been used effectively in rhino-plasty surgery for the augmentation and correction of nasal dorsum asymmetry and irregularities.5,22 How-ever, many surgeons have indicated a significant prob-lem about the usage of cartilage harvested from septum, conchal cartilage, or costa as a block. The problem is that cartilage is disabled when used for dorsal irregular-ities because of the resorption and distortion of the graft material.23–25In order to overcome these problems, diced

cartilage was suggested for use instead of cartilage blocks. During reshaping, the diced cartilage method was preferred because of its many advantages.5For this reason, we also prefer diced cartilage to block cartilage.

In numerous experimental studies, the cartilage was wrapped with a material in order to minimize the problem of resorption and increase the viability of the implanted cartilage.8 The Turkish delight method of wrapping the cartilage with Surgicel, developed by Erol in 2000, was accepted and was a milestone. This method was very popular because the study included 2,365

Fig. 2. Histological examination of diced cartilage grafts. (A) Peripheral chondrocyte proliferation in diced cartilage group (pcp), loss of chondrocytic nucleoli (*), viable chondrocyte (arrow), minimal fibrosis (F), and neovascularization (arrowhead) (hematoxylin and eosin [H&E], magnification 3200). (B) Pericondrium (P), peripheral chondrocyte proliferation (pcp), loss of chondrocytic nucleoli (*), isogenous groups (*), and territorial matrix (arrow) (H&E, magnification 3400). (C) Minimal fibrosis (F), minimal level of collagen fiber content in the green-stained area of cartilage matrix (Masson’s Trichrome stain; magnification 3200). (D) Minimal level of collagen fiber content in the brown-stained area of cartilage matrix (arrow) (Orcein stain; magnification 3400). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

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patients, and it had been used for 10 years with success-ful results.5 Many studies, which accepted or rejected this method, have been cited in the literature. Elahi also used cartilage wrapped with Surgicel and reported simi-lar results in 2003.26 However, Yilmaz et al. reported that this surgical intervention prevented the oxygen-ation of cartilage tissue for at least 48 hours, and this relative hypoxia led to a loss of regeneration potential that is important for the survival of chondrocytes.6 Erdogmus et al. reported that the use of calcium hydrox-ylapatite in combination with diced cartilage grafts does not have any long-term negative effects on chondrocyte viability.27

A study reported by Cakmak showed that the diced cartilage wrapped with Surgicel inhibited the prolifera-tion and viability of cartilage.7 Indeed, approximately 10% of the implanted cartilages maintained their viabil-ity.7 However, Daniel and Calvert observed that unex-pected implant resorptions occurred a few months after a rhinoplasty operation, when diced cartilage wrapped with Surgicel was used.8

In our study, when cartilage graft wrapped with Surgicel was evaluated with respect to its histological characteristics, severe loss of chondrocyte nuclei, decreased peripheral proliferation, severe fibrosis, and inflammation were observed. Significant differences were found in the rate of cartilage resorption among the

groups. Our study supported other studies for which the viability potential of cartilage graft wrapped with Surgi-cel was lower with higher resorption capability.6–8When the higher level of resorption in cartilage grafts wrapped with Surgicel was considered, modification of the carti-lage by wrapping it with biocompatible materials was suggested.10,28 Daniel and Calvert used diced cartilage wrapped with autologous temporal fascia in rhinoplasty and obtained consistent and significant results.8Ozturk

and Aydin used diced cartilage grafts wrapped with amniotic membrane.29 Bracaglia et al. used diced

carti-lage graft treated with human fibrin glue.30 Brenner et al. indicated that autologous fascia had no negative effect on durability of cartilage regeneration.28Fascia is a durable material with a high resistance power that functions as a cellular support.31 Brenner et al. indi-cated that fascia functions as a pericondrium, increases viability of chondrocytes, prevents the resorption of grafts, and maintains the general regenerative potential of the cartilage.28

However, there are some limitations to our study, including using another donor site and incision scarring for autologous fascia. Also, we did not prefer the use of temporalis fascia wrapped with diced cartilage in our study because of the incision scar and also because Kim et al.21 demonsrated that AlloDerm was found to be

signifi-cantly superior to temporalis fascia in terms of

Fig. 3. Histological examination of diced cartilage grafts wrapped with AlloDerm. (A) Pericondrium in the sample of cartilage tissue wrapped with AlloDerm (P), moderate fibrosis (F) and inflamation (star), neovascularization (*), and metaplastic bone formation (MB) (hematoxylin and eosin [H&E], magnification 3100). (B) Moderate peripheral chondrocyte proliferation (pcp), loss of chondrocytic nuclei (*), and viable chon-drocyte (arrow) (H&E, magnification 3400). (C) The content of collagen in green-stained cartilage matrix (Masson’s Trichrome stain, magnifi-cation 3200). (D) Moderate elastic fiber content in the brown-stained area of cartilage matrix (arrow) (Orcein stain, magnifimagnifi-cation 3400). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

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histopathological criteria. To overcome donor-site prob-lems, Achauer32used AlloDerm on the nasal dorsum with a limited number of patients, and also Jacson et al. and Gryskiewicz et al. used Alloderm in dorsal nasal irregular-ities and the correction of nasal contour deformirregular-ities.33–35

AlloDerm is an acellular human dermis matrix. After dermis is harvested from cadaveric skin, epider-mis and all the cellular components are removed by scrubbing the epidermis layer with detergent and anti-viral solutions. Afterward, the protein skeleton of the dermis is preserved in a frozen condition.36 Kim et al. compared cartilage grafts wrapped with AlloDerm to those wrapped with autologous fascia in their 2011 study.21 The observed results related to AlloDerm were histologically significant and showed the higher regen-eration potential of the chondrocytes. Additionally, con-tents of matrix collagen were preserved and metaplastic bone formation did not occur.21 AlloDerm

does not cause any immunological or foreign-body reac-tions, including rejection or reactions involving major histocompatibility class I and II antigens.37 For this

reason, it tends to be treated as an autograft when used in the body. Many studies also have shown that AlloDerm does not cause inflammatory and allergic reactions. On the other hand, Bateman and Jones

indi-cated the risks, including infection, tissue reaction, and rejection, caused by alloplastic materials in their study.12

In our study, when we compared the group of carti-lage grafts wrapped with AlloDerm to other groups in terms of histological characteristics, we found that the loss of chondrocyte nuclei and peripheral proliferation in cartilage wrapped with AlloDerm were more significant than observed in cartilages wrapped with Surgicel. In both groups, fibrosis and inflammation were moderate. Metaplastic bone formation and undesirable results were observed in both groups. However, there were no statis-tically significant intergroup differences. We compared PRFM to AlloDerm in terms of inflammation and fibro-sis and found that PRFM yielded significantly more suc-cessful outcomes.

Originally, PRFM was identified as a second-generation platelet solution by Choukroun in 2001.19 It

has been used in many fields of medicine such as den-tistry, dermatology, and plastic surgery.20 PRFM in par-ticular contains two important cytokines, interleukin (IL)24 and VEGF, in addition to other inflammatory cytokines (IL-1, IL-6, tumor necrosis factor [TNF] a, and TNF b), and is involved in the healing process of the tis-sues.38 Studies on healing bone have shown that PRFM caused fibroblastic proliferation and supported its

Fig. 4. Histological examination of diced cartilage grafts wrapped with Surgicel. (A) Minimal level of chondrocyte proliferation in the sample of cartilage tissue wrapped with Surgicel (pcp), variable level from moderate-to-severe inflammation (star), fibrosis (F), and fragmentation in cartilage tissue and metaplastic bone formation (MB) (hematoxylin and eosin [H&E], magnification 3100). (B) Severe loss of nucleus in chondrocyte (*) (H&E, magnification 3400). (C) Increasing fibrosis in peripheral tissue (F), minimal level of collagen fiber content in the green-stained area of cartilage matrix (Masson’s Trichrome stain, magnification 3200). (D) Minimal level of elastic fiber content in the brown-stained area of cartilage matrix (arrow) (Orcein stain, magnification 3400). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

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osteoblastic activity by triggering angiogenesis.39 In

their study on rabbits, Kuo et al. created cartilage defects in rabbits and compared PRFM group to the

con-trol group.17The authors reported significant healing in

PRFM implanted rabbits based on the results of MR and histological observation.

Fig. 5. Histological examination of diced cartilage grafts wrapped with PRFM. (A) Severe peripheral chondrocyte proliferation in the samples of cartilage tissue wrapped with PRFM (pcp) (hematoxylin and eosin [H&E], magnification 3200). (B) Numerous viable chondrocytes (arrow) (H&E, magnification 3400). (C) Plenty of elastic fiber content in the green-stained area of cartilage matrix (Masson’s Trichrome stain, magni-fication 3200). (D) Plenty of elastic fiber content in the brown-stained area of cartilage matrix (arrow) (Orcein stain, magnimagni-fication 3400). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

TABLE II.

The Results of Statistical Analysis for Histological Parameters Reviewed in Groups.

Between Diced Cartilage and Diced Cartilage Wrapped

With PRFM

Between Diced Cartilage Wrapped With AlloDerm and Diced Cartilage

Wrapped With PRFM

Between Diced Cartilage Wrapped With Surgicel and Diced Cartilage

Wrapped With PRFM Group Histopathologic Parameters Group A Versus Group D Group B Versus Group D Group C Versus Group D

Loss of chondrocyte nucleus 0.042* 0.026* 0.011*

Peripheral proliferation 0.407 0.092 0.038* Collagen 0.12 0.616 0.065 Elastic fiber 0.014* 0.093 0.041* Fibrosis 0.342 0.044* 0.086 Inflammation 0.023* 0.004* 0.003* Vascularization 0.589 0.293 0.179

Metaplastic bone formation 0.317 0.4 0.317

Fragmentation 0.674 0.209 0.022*

Resorption 0.045* 0.847 0.005*

*P value < 0.05 5 statistically significant. PRFM 5 platelet-rich fibrin matrix.

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CONCLUSION

In our research, when we compared PRFM to other groups in terms of contents of chondrocyte nuclei and inflammation, we found that PRFM was superior among the other groups. Of note, it caused less fibrosis than AlloDerm grafts. In terms of the loss of chondrocyte nuclei, peripheral chondrocyte proliferation, elastic fiber content of matrix, fibrosis, inflammation, and resorption parameters, PRFM preserved the viability of cartilage grafts more successfully than Surgicel material.

PRFM has significant advantages in that it ensures the chondrocyte viability of diced cartilage grafts and is also biocompatible, with relatively lesser inflammation and fibrosis.

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Şekil

Fig. 5. Histological examination of diced cartilage grafts wrapped with PRFM. (A) Severe peripheral chondrocyte proliferation in the samples of cartilage tissue wrapped with PRFM (pcp) (hematoxylin and eosin [H&amp;E], magnification 3200)

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