Goffart Yves, Karelle Sarah, Daele Jacques
Department of ENT/Head & Neck Surgery, CHR Citadelle, Bvd XII de Ligne, 4000 Liège, Belgium.
Eur J Plast Surg. 2015;38(5):355-362. doi: 10.1007/s00238-015-1085-2. Epub 2015 May 8.
Spreader grafts (SPG) are widely used for different purposes in rhinoplasty procedures. However, selection of the size of the grafts, trimming and fixation often proved time consuming and difficult. We used an original method of placement of "free" SPG to improve both ease of placement and fine trimming of the grafts. To assess pertinence of this approach, we evaluated retrospectively our rate of correction of the middle third of the nose.
We used a personal method for securing SPG after suturing upper lateral cartilages (ULC). Grafts were inserted between the ULC and nasal septum, adding fibrin glue for fixation. We reviewed the aesthetic results of a series of 420 consecutive rhinoplasties in whom free SPG were used in 218 patients and conventional fixed SPG were used in 33 patients. Retrospective analysis of the photographic data of all patients was performed. Adequacy of brow tip lines, symmetry and relative width of the middle third was assessed by an independent observer and the surgeon.
No evidence of postoperative displacement was noted. Symmetry of the middle third of the nose and adequacy of aesthetic brow tip lines were obtained in the vast majority of the patients. Comparable rates of middle vault correction and harmony were obtained in patients with free SPG or conventional SPG. On occasion during revision surgeries, we found the grafts resting in adequate position.
Free SPG placement appeared a straightforward and timesaving method in rhinoplasty procedures and proved especially meaningful when limited to moderate amount of support was needed in the middle vault reconstruction. Repositioning, resizing of the graft or placement of additional pieces of cartilage were feasible instantly if needed. This technique might help to obtain better correction of the middle third due to easiness and possibility of fine adjustments in rhinoplasty procedures. Level of Evidence: Level III, therapeutic study.
撑开移植片（SPG）在鼻整形手术中有多种用途。然而，移植片尺寸的选择、修剪和固定往往既耗时又困难。我们采用了一种放置“游离”SPG的原始方法，以提高移植片放置的便利性和精细修剪效果。为评估该方法的适用性，我们回顾性评估了鼻尖中部的矫正率。
我们采用一种个人方法，在上外侧软骨（ULC）缝合后固定SPG。将移植片插入ULC与鼻中隔之间，并添加纤维蛋白胶进行固定。我们回顾了420例连续鼻整形手术的美学效果，其中218例患者使用游离SPG，33例患者使用传统固定SPG。对所有患者的照片数据进行回顾性分析。由一名独立观察者和外科医生评估鼻尖线条的适宜性、对称性以及鼻尖中部的相对宽度。
未发现术后移位的迹象。绝大多数患者的鼻尖中部对称，美学鼻尖线条适宜。游离SPG患者和传统SPG患者的中鼻穹窿矫正率和协调性相当。在修复手术中，我们有时发现移植片位置合适。
游离SPG放置在鼻整形手术中是一种直接且省时的方法，尤其在中鼻穹窿重建仅需适度支撑时意义重大。如有需要，可立即对移植片进行重新定位、调整大小或添加额外的软骨片。由于该技术在鼻整形手术中操作简便且可进行精细调整，可能有助于更好地矫正鼻尖中部。证据级别：三级，治疗性研究。
