Classification of Spreader Flap Techniques

I am preparing a speech regarding spreader flaps these days, and I came across two articles of the same authors on this topic—one of them in your journal.

• Wurm J, Kovacevic M. A new classification of spreader flap techniques. Facial Plast Surg 2013;29:506

• Kovacevic M, Wurm J. Spreader flaps for middle vault contour and stabilization. Facial Plast Surg Clin North Am 2015;23(1):1–9

I congratulate the authors for these perfect studies. I do agree mosty with the authors. However, I have some comments of their study.

I have been using spreader flap technique for more than 20 years as one of the first performers of this technique. I published an article (1997) regarding this technique in the past.[1] I would like to see my article in the references of their articles. They did not see my article, possibly because it is a relatively old article and published as a letter to the editor in Plastic and Reconstructive Surgery journal. However, my article has been cited by more than 30 articles in the past 10 years, including Byrd and Gruber's studies regarding spreader flap.

The main problem is not being cited or not, but the authors suggested that these different suture types for spreader flaps were first described by them. However, these have already been described in my article. If the authors would look at my article, they could see the suture techniques described are very similar or even the same with their technique, for instances:

1. I never used conventional suture technique, and this type of suture was not mentioned in my article.

2. Basic spreader flap with anchoring suture is my favorite and it was defined as spreader flap with “intercartilaginous suture” in my article.

3. Support spreader flap was defined as spreader flap with “transcartilaginous suture.”

4. Interrupted spreader flap was shown to be obtained as “split incisions” to make bending easier over the folding axe in the drawing and in the figure caption.

All this information exists in the figure and its caption in my aforementioned article[1] and more detailed information can be found in the text.

Second point is the authors noted in both their articles that the “spreader flap” technique was first described by Oneal and Berkowitz (1998).[2] However, this is not true. Although the term “spreader flap” was first mentioned by these authors, the technique was already described earlier. My article was probably the first publication that described this method (spreader flap) in an international English journal, which is dated 1997. To the best of my knowledge, the first publication was appeared in a Spanish Plastic Surgery journal named “Cirugia Plastica Ibero-Latinoamericana” by Dr. Lerma.[3] I was not aware of his study when my article was published. Then, he kindly warned me and the journal with a letter after my article appeared in the journal.

I think if these details are taken into consideration by the authors, their future studies will be more complete.

• References

• 1 Seyhan A. Method for middle vault reconstruction in primary rhinoplasty: upper lateral cartilage bending. Plast Reconstr Surg 1997; 100: 1941-1943
• 2 Oneal RM, Berkowitz RL. Upper Lateral Cartilage Spreader Flaps in Rhinoplasty. Aesthet Surg J 1998; 18 (05) 370-371 . doi: 10.1016/S1090-820X(98)70095-0
• 3 Lerma J. Reconstruction of the middle vault: the “lapel” technique. Cir Plast Ibero Latinoam 1995; 21: 207