Fixation of the Cartilaginous Vault with Barbed Suture in Closed-Approach High-Septal-Resection Dorsal Preservation Rhinoplasty

Overview

Fixing the cartilage part of the nasal framework is an important step in preservation rhinoplasty because it reduces the chance the hump comes back. This paper presents a fixation technique using a barbed suture, which grips tissue along its length rather than relying on knots. Forty six patients who had closed approach dorsal preservation with high septal resection between August 2019 and March 2020 were reviewed retrospectively.

Sections of note

• Retrospective study of 46 patients; the paper states level of evidence IV.
• Patients were divided by fixation suture used: barbed suture, 21 patients, or conventional suture, 25 patients.
• All had closed approach high septal resection dorsal preservation rhinoplasty.
• Standardized side view photographs at 1 month were examined for any degree of hump recurrence.
• The Rhinoplasty Outcome Evaluation scale was applied at 12 months.
• Hump recurrence was found in one patient in each group, P greater than 0.05.
• Satisfaction scores and the number of satisfied patients did not differ significantly between groups.
• The authors state barbed sutures can be used, taking advantage of easier placement in closed rhinoplasty.

What it means for a patient

• The two suture types performed the same on both hump recurrence and satisfaction.
• The stated advantage of the barbed suture is that it is easier to place when working inside the nose without an open incision.
• Recurrence was checked at only one month, which is early for a hump to reappear.
• Twenty one against 25 patients is too small to detect anything but a large difference.

Why this paper matters

Hump recurrence is the main failure mode of dorsal preservation, and how firmly the framework is fixed is the surgeon's main lever against it. This study tests one fixation method against the standard. Its size and one month recurrence assessment limit what it can establish.

Terms

• Cartilaginous vault: the cartilage part of the nasal framework.
• Barbed suture: a stitch with projections along its length that grip tissue without knots.
• Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
• High septal resection: removing a strip of septum just below the bridge.
• Closed approach: surgery through incisions inside the nose only.
• Hump recurrence: the bump becoming visible again after surgery.