Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
A spreader flap, or autospreader flap, is a flap used for dorsal reconstruction in primary rhinoplasty after cartilage dorsum excision. 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.
OBJECTIVE:
To evaluate the efficacy of autospreader flap for midvault reconstruction after humpectomy in primary rhinoplasty.
PATIENTS AND METHOD:
This prospective study was done on 124 patients in Erbil, from February 2010 to Jan. 2014. All patients who underwent primary rhinoplasty and requiring humpectomy are included in this study. 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. 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 in thick cartilage. The flap is then secured to the dorsal edge of the reduced dorsal septum. Data were entered and analyzed using the statistical package for social sciences SPSS version (18).
RESULTS:
In 124 patients who underwent an open approach rhinoplasty (44 patients were male and 80 patients were female), the autospreader flap almost always reconstructed the middle third of the nose. It was easy to execute in the open approach. At surgery, seven patients needed spreader grafts because the flaps were too narrow. Postoperatively, twelve patients exhibited inadequate nasal width.
CONCLUSION:
Autospreader flap is a suitable technique for restoration of midvault after humpectomy in primary rhinoplasty. The application of autospreader flap allows the surgeon to reconstruct the internal valve and design an aesthetically pleasing dorsal nasal line.
KEYWORDS: primary rhinoplasty, autopreader flap, cartilage dorsum excision, dorsal nasal reconstruction.