The Evolution of the SPF-SPLF Graft in Rebuilding the Dorsum in Revision Rhinoplasty-an Update in an Over 300 Case Series

Overview

Rebuilding an over-resected bridge in revision surgery has relied on solid rib grafts (which can warp) or diced cartilage in fascia (which can look ill-defined or lumpy). Robotti's group describes the SPLF graft, used since 2017 and refined through more than 300 cases: layers of perichondrium, laminated rib cartilage and rectus fascia assembled and placed on the dorsum as one unit, sometimes with added "rib plaster."

Sections of note

• More than 300 cases between 2021 and 2024.
• Variations in dimension, shape and composition allowed intraoperative customisation.
• Reported results: consistent dorsal height, smooth contour and well-defined dorsal aesthetic lines "indistinguishable from the native dorsum."
• No infections, graft warping or significant long-term complications reported.
• An algorithm for choosing graft configuration is proposed. Level of Evidence IV.

What it means for a patient

• For a bridge that was taken down too far in a previous operation, this is an alternative to a solid rib block or diced cartilage.
• In this large series the graft did not warp or become infected, two known problems with rib.
• Results are reported by the operating surgeon without independent measurement or a comparison group.

Why this paper matters

It is one of the largest single-surgeon series of a specific dorsal reconstruction technique in revision rhinoplasty. Limits: retrospective, no objective outcome scores in the abstract, single surgeon.

Terms

• Perichondrium: the membrane covering cartilage, used as a smooth outer layer.
• Rib lamination: slicing rib cartilage into thin sheets that resist warping.
• Rectus fascia: the sheath of the abdominal muscle, used as a wrap.
• Diced cartilage in fascia (DCF): chopped cartilage wrapped in fascia, the main competing technique.
• Dorsal aesthetic lines: the highlight lines from brow to tip that define the bridge from the front.