The role of upper lateral cartilage in dorsal reconstruction after hump excision: section 1. Spreader flap modification with asymmetric mattress suture and extension of the spreading effect by cartilage graft

A spreader flap, or autospreader flap, is a flap used for dorsal reconstruction in primary rhinoplasty after cartilage dorsum excision. Despite its significant advantages, the spreader flap also has distinct shortcomings. The most common problem encountered in using a spreader flap is the technique’s inability to provide adequate dorsal width compared with spreader grafts. Additionally, the use of a spreader flap has not been described for special cases such as crooked noses, cases with minimal dorsal humps, and secondary cases. This report presents the authors’ modification of the spreader flap technique to expand its indications and extend the spreader effect down to the entire dorsum. This modification positions and fixes the medial borders of the upper lateral cartilages (ULCs) on both sides of the septum by asymmetric mattress sutures. Using the ULCs without folding affords the opportunity to restore a dorsum with sufficient width. Different entry and exit points of the suture help to maintain the cartilage substance horizontally rather than folded as in the conventional spreader flap technique. Another drawback of the spreader flap technique is its inability to address the lower third of the dorsum when ULCs do not extend down to the anterior septal angle (ASA). In these cases, attempts were made to extend the spreader effect by placing two small cartilage grafts on both sides of the ASA. Over a period of 2 years, the authors operated on 169 patients. For 81 of these patients, the modified spreader flap alone was used, and for the remaining 88 patients, both the modified spreader flap technique and ASA grafting (combined modification) were used. During a mean follow-up period of 17 months, no narrowing in the middle nasal dorsum and no inner valve deficiencies were seen in any of the cases.