See how to carve a double wide spreader graft to improve internal valve collapse
Dr. Thomas Lamperti shows an intra-operative video showing how he creates a double-wide spreader graft to treat internal valve collapse. This includes carving of the septal cartilage, suturing of the two pieces of cartilage together, and then the final tapering of the ends of the graft.
"This is Doctor Thomas Lamperti. Today I'm going to talk about how we carve a double wide spreader graft. We'll start with a portion of harvested septal cartilage that we previously harvested during the case to straighten the septum. We have a nice straight piece as you can see. Now we'll go ahead an cut two strips from the septum cartilage to form the spreader graft. The standard spreader graft involves just one piece of cartilage, but in today's patient he had quite a bit of unilateral pinching or collapse in the middle third of his nose. I felt that in order to really correct this we would need a portion of spreader cartilage that was larger than what the septum itself would allow. To overcome this what I'll do is laminate or use a double-wide spreader graft technique.
What I'm doing here is securing the two pieces of cartilage together using suture. This suture is actually dissolvable and in a few months when it is no longer around the cartilage would have scarred to itself sufficiently that it will be quite stable. The graft is also sewn into the nose itself so that it is secured to the upper lateral cartilages and septum. Once we've completed suturing we'll cut the ends and then proceed with trimming and carving the double wide graft now. This mainly will involve tapering the ends so that they integrate well with the nasal bones above and the nasal tip cartilages below. I'll typically place the upper end of the spreader graft right between the nasal bone and septum to allow the bone to hide and obscure this transition point. Now you'll be able to see the final shape of the double-wide graft. I do fashion this shape based off of the level of pinching and ultimate level of collapse the patient has."