The spreader flap in primary rhinoplasty.
BACKGROUND
In a primary rhinoplasty that requires a humpectomy, the dorsal aspect of the upper lateral cartilages is commonly discarded. Many of these patients need spreader grafts to reconstruct the middle third of the nose. However, it is possible to reconstruct the upper lateral cartilages into "spreader flaps" that act much like spreader grafts.


METHODS
A tunnel is created on the underside of the upper lateral cartilage, which is released from the cartilaginous septum and also from its attachment to the nasal bone (medially). It is then rolled on itself to make a spreader flap, which is secured with sutures. Scoring along the dorsal edge of the upper lateral cartilage may be necessary. The flap is then secured to the dorsal edge of the reduced dorsal septum.


RESULTS
In 21 patients who underwent an open approach (and four patients who underwent the closed approach), the spreader flap almost always reconstructed the middle third of the nose. It was easy to execute in the open approach but difficult in the closed approach. At surgery, two patients undergoing the open approach and one patient undergoing the closed approach needed spreader grafts because the flaps were too narrow. Postoperatively, only one patient (operated on by the open approach) exhibited inadequate nasal width.


CONCLUSIONS
Spreader grafts are the standard for reconstructing the middle third of the nose. However, the spreader flap avoids harvesting and carving cartilage for those grafts. In the open approach, the technique is easy to execute. Conclusions could not be drawn regarding the long-term success with the closed approach.
Gruber
Ronald P
RP
Stanford, San Francisco, and Campbell, Calif.; and Ann Arbor, Mich. From Stanford University, the University of California, San Francisco, private practice, and the University of Michigan.
Park
Eddie
E
Newman
Jennifer
J
Berkowitz
Lawrence
L
Oneal
Robert
R
D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D015331:Cohort Studies; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009295:Nasal Bone / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000002:abnormalities*; D012225:Rhinoplasty / Q000379:methods*; D012307:Risk Factors; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome