Unique Uses of SPY: Revision Rhinoplasty

Amirlak B, Dehdashtian A, Sanneic K, Lu KB, Cheng J.

PubMed 31624661 Publisher (DOI)Free full text (PMC)

What this paper says

A case report in which laser angiography showed poor blood flow to the nasal tip after structural grafts were placed, then confirmed that topical nitroglycerin restored it, allowing the grafts to stay in place.

Overview

Skin flap death is a serious complication in reconstructive surgery, and clinical examination does not always predict it. The SPY Elite laser angiographic system measures tissue perfusion objectively and has been used in breast reconstruction. This report describes applying it during a revision rhinoplasty.

Sections of note

Single case report during revision rhinoplasty.
Poor blood flow to the nasal tip was seen after structural grafts were placed at the tip.
SPY angiography was performed to assess that reduced perfusion before removing the grafts.
Topical nitroglycerin was applied and repeat imaging performed.
Perfusion of the nasal tip was restored, confirmed by the angiography system.
The objective findings allowed the grafts to remain in place, leading to what the authors describe as an optimal cosmetic result.
The authors recommend using the technology when tissue viability is difficult to judge from clinical examination.

What it means for a patient

Placing grafts to project the tip stretches the overlying skin and can reduce its blood supply.
Without objective imaging, the usual response is to remove the grafts, which sacrifices the intended result.
A topical drug that widens blood vessels restored flow in this case.
Limits: one patient, so this shows the approach is possible but not how often it works or when removal remains necessary.

Why this paper matters

Skin necrosis on the nose is disfiguring and hard to correct, so surgeons remove grafts at the first sign of trouble. Objective perfusion measurement could distinguish a genuine threat from a transient one. A single case cannot establish thresholds for that decision.

Terms

Perfusion: Blood flow through tissue.
Laser angiography: Imaging that shows blood flow using an injected fluorescent dye and laser light.
Hypoperfusion: Reduced blood flow to an area.
Structural graft: A cartilage piece placed to hold shape and support.
Nitroglycerin: A drug that widens blood vessels, applied here to the skin.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Inadequate tissue perfusion is a serious complication following reconstructive surgeries. Skin flap necrosis, especially in the head and neck area, may have significant cosmetic consequences. Although clinical exam is the mainstay in evaluating perfusion, it may not always predict ischemic problems. The SPY Elite laser angiographic system, which has been widely used to analyze tissue perfusion in postmastectomy skin flaps, has been shown to be able to evaluate tissue perfusion objectively. We describe a revision rhinoplasty case where hypoperfusion of the nasal tip was seen following placement of structural grafts to the nasal tip, and before the grafts being removed SPY, angiography was used to evaluate if topical nitroglycerin alone could correct hypoperfusion of the nasal tip rather than removal of structural grafts. A SPY angiography was performed to evaluate the hypoperfusion to the nasal tip. Repeat imaging was then performed following treatment with topical nitroglycerin alone. Perfusion of the nasal tip was restored and confirmed by SPY angiography system. The objective findings from the SPY angiography allowed the grafts to remain in place and lead to optimal cosmetic result. Due to the critical information SPY angiography provided in this case, we recommend the use of technology when evaluating reconstructive cases in which the viability of the tissue may be difficult to deduce from clinical exam.

Abstract as indexed by PubMed; the article is open access (PubMed Central).