Polypropylene vs. Polydioxanone: How to Fix Septal Extension Graft?

Area of Science:

• Plastic Surgery
• Biomaterials Science
• Surgical Outcomes Research

Background:

• Septal extension grafts (SEGs) are crucial for nasal structure support in rhinoplasty.
• The long-term rotational stability of SEGs is influenced by fixation methods.
• Nasal skin thickness is a potential factor affecting graft stability and surgical outcomes.

Purpose of the Study:

• To compare the long-term rotational stability of SEGs fixed with polypropylene (PP) versus polydioxanone (PDO) sutures.
• To evaluate the impact of patient skin thickness on the rotational stability of SEGs.
• To assess revision rates related to graft instability in rhinoplasty.

Main Methods:

• Retrospective analysis of 308 rhinoplasty patients with SEG placement.
• Grouping patients by suture material (PP vs. PDO) and skin thickness (thin, medium, thick).
• Measuring Tip Rotation Angle (TRA) preoperatively and at 1 month and 1 year postoperatively using standardized photographs.

Main Results:

• Mean rotation loss was significantly higher with PDO (2.16°) compared to PP (0.67°) sutures (p < 0.01).
• Greater rotation loss was observed with PDO in medium- and thick-skinned patients, but not in thin-skinned patients.
• Revision surgery for rotation complications occurred in 5.2% of patients, predominantly in thick-skinned individuals using PDO.

Conclusions:

• Polypropylene sutures provide superior long-term rotational stability for SEGs compared to polydioxanone sutures.
• Individualized suture selection based on nasal skin thickness is recommended for optimizing rhinoplasty outcomes.
• This study highlights the importance of material choice in graft fixation for predictable aesthetic results.