The spreader graft is a longitudinal graft placed between the dorsal septum and the upper lateral cartilage in a submucoperichondrial pocket. This graft has functional and aesthetic indications. Although placement and suturing of the spreader graft to the septum is an easy part of rhinoplasty for the experienced surgeon, it can be difficult and time-consuming for young surgeons. Here we suggest a very simple technique for easier placement and suturing of spreader grafts.
The spreader graft is a longitudinal graft (25–30 mm in length and 3 mm in width) placed between the dorsal septum and the upper lateral cartilage in a submucoperichondrial pocket. This graft may be placed either unilaterally or bilaterally, depending on the indication. Spreader grafts are used to restore and/or maintain the internal nasal valve, recreate or improve the dorsal aesthetic lines, straighten a dorsally deviated septum, and reconstruct an open-roof deformity. Spreader grafts are placed and sutured to the dorsal septum with through-and-through PDS 5–0 horizontal mattress sutures. The upper lateral cartilages are then reapproximated to the spreader graft/septum complex.
Although the placement and suturing of the spreader graft to the septum is a routine part of rhinoplasty for the experienced surgeon, it can be difficult and time-consuming for young surgeons. Dropping the graft into the mucoperichondrial pocket (between the septum and mucoperichondrial flap) is one of the most common problems. Graft displacement during suturing is another common problem. We suggest a very simple technique to overcome these problems.
In this technique, the surgeon places adequate layers of gauze along the septum to reapproximate the mucoperichondrial flap to the septum. The same technique should be applied to the opposite side ( Fig. 1 ). Reapproximation of the mucoperichondrial flaps to the septum by packing the nose will close the space between the septum and mucoperichondrium and thus the spreader grafts will not drop in during suturing. In addition, the presence of the gauze packing will absorb the blood and this can improve visibility for the surgeon ( Fig. 2 ).