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

[BACKGROUND] To compare the long-term rotational stability of septal extension grafts (SEGs) fixed with polypropylene (PP) versus polydioxanone (PDO) sutures in rhinoplasty and to evaluate the impact of skin thickness on surgical outcomes.

[METHODS] A retrospective analysis was conducted on 308 patients who underwent rhinoplasty with SEG placement between January 2022 and June 2024. Patients were grouped according to the suture material used for caudal septal fixation (PP vs. PDO) and stratified by skin thickness (thin, medium, thick). Tip Rotation Angle (TRA) was measured from standardized lateral photographs at preoperative, 1-month, and 1-year postoperative time points. All measurements were performed by a blinded observer using the ImageMeter application. Rotation loss and revision rates were compared across groups.

[RESULTS] TRA increased from a preoperative mean of 92.65° to 101.6° at 1 month postoperatively, then stabilized at 100.23° at 1 year. Mean rotation loss was significantly higher in the PDO group (2.16° ± 2.98°) compared to the PP group (0.67° ± 1.02°) (p < 0.01). Subgroup analysis revealed no significant difference in thin-skinned patients, but significantly greater rotation loss with PDO in medium- and thick-skinned patients (p < 0.01). Revision surgery due to rotation-related complications was required in 5.2% of patients, with a majority (81.2%) occurring in thick-skinned individuals from the PDO group. No adverse suture-related reactions were observed.

[CONCLUSION] Polypropylene provides superior long-term rotational stability in SEG fixation compared to polydioxanone, particularly in patients with medium or thick nasal skin. Suture selection should be individualized based on patient skin type to optimize outcomes..