Double Layer Lateral Crural Perichondrial Flap for Coverage and Stabilization of Tip Graft

Aesthetic Plast Surg. 2022 Apr;46(2):862-870. doi: 10.1007/s00266-021-02549-0. Epub 2021 Sep 27.

Abstract

Background: Tip plasty is the most important step of rhinoplasty. To achieve symmetrical cartilages with ideal tip rotation, projection and supratip break many techniques were defined. Besides suture techniques, tip grafts still maintain their importance and widely used among surgeons. However, graft visibility and distortion are the main drawbacks of this technique. In this study double-layered lateral crural perichondrial flap technique was introduced to prevent graft visibility and distortion as a novel technique.

Methods: A total of 16 patients who underwent rhinoplasty with this novel technique were enrolled in this retrospective study. Patient satisfaction was assessed with Rhinoplasty Outcome Evaluation Questionnaire (ROE-Q). Graft visibility and asymmetry of tip defining point as an indicator of graft distortion were evaluated by two independent Plastic, Reconstructive and Aesthetic surgeons. Pre and postoperative photographs were taken and used for evaluation. A three-point Likert scale was used for assessment. Cohen's Kappa statistic and percent agreement test were used to test inter-rater reliability RESULTS: The mean follow-up time was 15 months (ranging between 12 and 19 months). According to the ROE-Q score, the mean total preoperative score was 6,25 and the mean total postoperative score was 18,06 (p<0,05). No or minimal evident graft visibility and asymmetry of tip defining point was observed in 12 patients and 10 patients, respectively. Mild evident graft visibility was observed in only 1 patient with thin skin. Severe evident graft visibility or asymmetry of tip defining point was not observed in none of the patients.

Conclusion: The double-layer crural perichondrial flap was an effective and sufficient method for preventing graft visibility and graft distortion. Features like easy and fast flap elevation, no additional comorbidity, being autologous tissue and sufficient flap length and thickness make this technique valuable and useful.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Lateral crus; Perichondrial flap; Tip graft; Tip graft distortion; Tip graft visibility.

MeSH terms

  • Esthetics
  • Follow-Up Studies
  • Humans
  • Nasal Cartilages* / surgery
  • Nasal Septum / surgery
  • Reproducibility of Results
  • Retrospective Studies
  • Rhinoplasty* / methods
  • Treatment Outcome