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Cited by 162Nasal Surgery and Airway StudiesReconstructive Facial Surgery TechniquesCleft Lip and Palate Research

The Spreader Flap in Primary Rhinoplasty

Gruber, Ronald P., Park, Eddie, Newman, Jennifer, Berkowitz, Lawrence, Oneal, Robert·2007·Plastic and Reconstructive Surgery
DOI 10.1097/01.prs.0000259198.42852.d4
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Abstract

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.

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  • Synthetic materials can be useful in revision surgeries, especially where there is inadequate cartilage.

    “The synthetic materials can be useful in revision surgeries, especially where there is inadequate cartilage [27, 29].”

    From The value of spreader grafts in rhinoplasty: a critical review (2012) · cites this paper as [29]

  • Auto-spreader flap avoids harvesting and carving cartilage for grafting from other locations.

    “This technique avoids harvesting and carving cartilage for grafting from other locations [29, 36].”

    From The value of spreader grafts in rhinoplasty: a critical review (2012) · cites this paper as [29]

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Authors
Gruber, R. P., Park, E., Newman, J., Berkowitz, L., & Oneal, R.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
Plastic and Reconstructive Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2007-05
Volume
119
Issue
6
Pages
1903-1910
ISSN
0032-1052 (ISSN-L)
DOI
10.1097/01.prs.0000259198.42852.d4
OpenAlex
W1995073437
Cited by
162
References
20
Citations by year
2026: 5 · 2025: 7 · 2024: 7 · 2023: 12 · 2022: 9 · 2021: 13 · 2020: 14 · 2019: 5 · 2018: 11 · 2017: 9 · 2016: 7 · 2015: 11 · 2014: 10 · 2013: 13 · 2012: 3
FWCI
5.97
Type
journal article
Language
en
Open access
closed
Locations
  • Plastic & Reconstructive Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
  • Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Cleft Lip and Palate Research
Keywords
primary rhinoplasty, spreader grafts, upper lateral cartilages, nasal reconstruction, open rhinoplasty, closed rhinoplasty, nasal width
MeSH terms
Adolescent, Adult, Cartilage, Esthetics, Follow-Up Studies, Humans, Male, Nasal Bone, Nasal Septum, Nose, Rhinoplasty, Risk Factors, Surgical Flaps, Suture Techniques, Cohort Studies, Treatment Outcome

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