Refining the SPLF Graft: Innovations in Revision Rhinoplasty

Robotti E, De Bernardis R, Clauss A, Leone F, Cottone G, Robotti S, Alessandri Bonetti M, Persichetti P.

PubMed 42012848 Publisher (DOI)

What this paper says

A technique paper on the SPLF graft, a layered sandwich of perichondrium, cartilage lamina and fascia used to rebuild the bridge in revision rhinoplasty, describing refinements made since it was first devised in 2017.

Overview

Rebuilding the bridge in a revision is hard: solid rib grafts warp and shift, and diced cartilage in fascia can leave the bridge poorly defined. The senior author's answer is a multilayered construct built during the operation. This paper describes how that construct has been refined. It is a technique description, Level of Evidence V, with no patient series and no numbers.

Sections of note

SPLF stands for sandwich of perichondrium, lamina and fascia; first devised in 2017.
Stated problems with existing methods: warping and displacement of solid rib grafts, insufficient dorsal definition with diced cartilage fascia.
The layered design allows height, contour and lateral continuity to be adjusted during the operation.
Refinements listed: variations in lamination thickness, shape and extensions, additional laminations, and use of "rib plaster."
Claims made for it: smooth contours, defined dorsal aesthetic lines, consistent long-term results.
Level of evidence V; the abstract reports no patient numbers, follow-up or complication rates.

What it means for a patient

This concerns the hardest part of revision surgery, rebuilding a bridge that has lost its support or shape.
The claims are the author's own clinical impression, not measured outcomes, and no comparison with rib or diced cartilage methods is offered.
Any of these methods requires harvesting cartilage, usually from a rib, with its own recovery.

Why this paper matters

Dorsal reconstruction has no agreed standard, and each camp defends its own construct. This documents one refined option in detail. Comparative outcome data against solid rib and diced cartilage fascia grafts remain absent.

Terms

Revision rhinoplasty: an operation to correct the result of a previous nose operation.
Perichondrium: the thin membrane covering cartilage.
Fascia: a sheet of connective tissue, often taken from the temple, used to wrap or cover grafts.
Diced cartilage fascia (DCF): chopped cartilage wrapped in fascia to build up the bridge.
Warping: a cartilage graft bending over time.
Dorsal aesthetic lines: the two shadow lines running down the bridge from the brows to the tip.

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

From the abstract

“Reconstructing the dorsum in revision rhinoplasty remains a complex challenge. Traditional methods such as solid rib grafts and diced cartilage fascia (DCF) grafts present significant limitations, including warping, displacement, and insufficient dorsal definition. First devised in 2017, the SPLF (sandwich of…”

Excerpt; the full abstract is on PubMed.