In rhinoplasty, the 'open sky' (external) approach provides superior visualization compared to the endonasal approach. The transcolumellar incision is placed at the narrowest part of the columella. Healing of this transcolumellar scar in the standard open rhinoplasty is primarily dependent on closure of which anatomical layer?

• A Skin alone with 6-0 nylon interrupted sutures
• B Periosteum of the nasal spine
• C Cartilaginous interdomal strut with PDS sutures
• D Subcutaneous fibromuscular tissue (SMAS equivalent) with separate absorbable sutures before skin closure ✓

Explanation

Meticulous closure of the transcolumellar incision in open rhinoplasty requires a two-layer closure — the subcutaneous fibromuscular layer (equivalent of SMAS) is first approximated with absorbable sutures (5-0 PDS or Vicryl) to relieve tension from the skin edges, followed by precise skin closure with fine nylon. Tension-free skin closure produces the finest scar. Closing skin alone under tension leads to widened, hypertrophic scar. The interdomal sutures address tip projection, not the transcolumellar scar.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.