A Novel Securing Technique for Nasal Onlay Grafts

Goals/Purpose:

A successful rhinoplasty is judged by both the patient and the surgeon and whether they are satisfied with the outcome. The manipulation of the tip and dorsal cartilage can leave contour irregularities that can be difficult to manage. Most dorsal contour irregularities require a thin, pliable piece of cartilage to camouflage the area. An onlay graft must be carved exactly to fit the deformity and secured in a precise location. It is often challenging to secure these onlay grafts to the precise position to camouflage the deformity and avoid subsequent visibility and secondary deformity.

Methods/Technique:

Autologous nasal onlay grafts care used to camouflage contour deformities and all grafts are secured using a transcutaneous plain gut bolster stitch.  This technique was utilized on 52 patients who underwent rhinoplasties. Outcomes were examined to assess frequency of revision operations, infections, graft malposition, scarring and visibility.

Results/Complications:

Of the 52 patients that had nasal onlay graft placement using the transcutaneous suture fixation technique, there were no revision operations, infections, graft malposition, external scars from the sutures, or visibility with one year follow up.

Conclusion:

This technique utilizes autologous cartilage and has no additional cost or donor site morbidity. It also ensures precise cartilage positioning and fixation, which reduces the risk of malposition, visibility, and the need for re-operation. Additionally, in the senior author's hands, it is more accurate, easier, and less time consuming than traditional fixation to the underlying skeleton framework, especially when placing grafts along the middle and upper third of the nose.

Pictures A-K. A. External deformity noted on exam. B. External deformity marked C. Graft tailored to precisely fit the defect (the edges of the graft should be beveled appropriately when using solid cartilage grafts) D. Suture markings

E. Suture markings transferred to the graft F. Transcutaneous 5-0 plain suture on Keith needle placed through the superior marking on the skin G. Suture placed through superior marking on the graft H. Suture placed back through inferior marking on the graft I. Transcutaneous suture placed back through inferior skin marking J. Sutures pulled to draw the graft into position in the precise area of deformity K. Graft in position after being loosely tied.