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Surgical Technique |

The Use of Percutaneous Sutures for Graft Fixation in Rhinoplasty

Matthew Karen, MD; Timothy Lian, MD; Fred Stucker, MD
Arch Facial Plast Surg. 2003;5(2):193-196. doi:10.1001/archfaci.5.2.193.
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We reviewed our 10-year experience using percutaneous suturing to secure cartilage grafts in rhinoplasty. A total of 382 patients having up to 4 percutaneous sutures per surgery were analyzed. Cases using this suture technique included lower lateral onlay grafts, dorsal onlay grafts, tip grafts, and intact conchal cartilage grafts to repair nasal valve collapse. Sutures are ideally placed in a horizontal mattress fashion beginning at the skin surface, continuing into the nasal cavity, and then out through the skin. Sutures are strategically placed to secure the graft and at times stent open the nasal valve. The suture is tied loosely over the skin taking in to consideration the anticipated edema formation. There is no need to use a bolster technique. Sutures are removed at the second postoperative visit. Long-term follow-up reveals precise graft placement. There are in most instances no visible suture marks and our results achieve over 95% patient satisfaction. Percutaneous suture placement is a simple technique that allows precise graft placement and fixation without resultant scarring. It coapts the skin and soft tissues to the grafted nasal skeleton and prevents fluid accumulation, hematoma formation, and graft migration. We believe that it aids in decrease long-term tissue edema and excessive fibrosis, therefore promoting quicker healing. Our patients are both functionally and cosmetically pleased.

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Figures

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Figure 1.

Histologic view of conchal cartilage removed from nasal dorsum during revision rhinoplasty, more than 2 years after the first procedure.

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Figure 2.

Percutaneous suture being tied over a Freer elevator.

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Figure 3.

A, Right oblique preoperative nasal collapse. B, Right oblique 5 days after placement of conchal cartilage graft with percutaneous sutures in place. C, Right oblique 2 months postoperatively. D, Left oblique preoperative nasal collapse. E, Left oblique 5 days after placement of conchal cartilage graft with percutaneous sutures in place. F, Left oblique 2 months postoperatively.

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Figure 4.

A, Five days after placement of percutaneous suture. B, Five years after surgery with percutaneous sutures.

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Figure 5.

Suture complication, persistent alar crease marks.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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