The SPF-SPLF Graft: Building the Ideal Dorsum in Revision Rhinoplasty

Robotti E, Leone F.

What this paper says

Across 23 revision cases followed more than 18 months, a layered graft combining perichondrium, rectus fascia and a thin rib lamination gave defined bridge edges without the visible borders of solid rib or the shapeless contour of wrapped diced cartilage.

Overview

Two standard options exist for rebuilding the bridge in revision surgery, and each has a characteristic failure. Solid rib segments show their edges and can warp; diced cartilage in fascia avoids that but produces vague borders and a tubular look. This technique combines three layers into a single unit covering the whole bridge.

Sections of note

The construct combines three elements: perichondrium, rectus fascia, and a rib lamination.
Two forms exist: the sandwich of perichondrium and fascia, and the sandwich of perichondrium, rib lamination and fascia.
Placed as a single unit over the entire bridge, it avoids junction irregularities between separate graft segments and contour asymmetries from uneven diced cartilage distribution.
Stated problems with solid rib segments: edge visibility, potential warping and distortion.
Stated problems with diced cartilage in fascia: obtuse ill-defined borders, poor shape control, contour asymmetries, and often a tubular appearance.
Experience covers more than 18 months in 23 cases at the time of writing.
Reported results: adequate edge definition and shadowing, precise tailoring, and proper dorsal height; all three elements are harvested from the same donor site with minimal scarring.

What it means for a patient

All three layers come from one donor site, so only one additional incision is made.
The graft covers the whole bridge as one piece rather than several segments that can show where they meet.
Limits: 23 cases, one team, no comparison group, no outcome scores or complication rates, and follow-up stated only as more than 18 months.

Why this paper matters

Bridge reconstruction in revision surgery has been a choice between two techniques with opposite failure modes, and combining their materials is a direct response. Single-unit coverage addresses junction irregularity specifically. The small series without measurement leaves the claimed advantage untested.

Terms

Perichondrium: The membrane covering cartilage.
Rectus fascia: The fibrous sheath over the abdominal muscle, used as a graft.
Rib lamination: A thin sheet shaved from rib cartilage.
Warping: Bending of a solid cartilage graft after implantation.
Diced cartilage in fascia: Diced cartilage wrapped in a fascia sleeve before placement.

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

From the abstract

“Achieving a natural appearing dorsum in secondary rhinoplasty remains an elusive goal. An inherent contradiction exists between the two most usually used techniques: solid rib segment and diced cartilage fascia constructs. The former will often cause edge visibility, in addition to potential warping and distortion;…”

Excerpt; the full abstract is on PubMed.