Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft.

BACKGROUND: The closure of nasal septal perforations can be challenging based on the etiology, location, and method of closure. We report on a novel method of closure for nasal septal perforations using a unilateral mucosal rotational flap and acellular dermal interposition graft.

METHODS: Twenty patients with nasal septal perforations of various etiologies underwent our method of repair through a closed, endonasal approach.

RESULTS: Out of 20 patients, 17 demonstrated successful closure of their septal perforations, consistent with an 85% success rate. Based upon size, closure rates were 89% for small perforations (<1 cm), 80% for medium perforations (1-2 cm), and complete closure for a single large perforation (>2 cm). Of 20 patients, 19 were completely asymptomatic following surgical intervention, and of the 3 with failed repairs, only 1 patient required revision surgery for persistent symptoms.

CONCLUSION: Nasal septal perforations may cause bothersome symptoms and present a significant reconstructive challenge. Native septal tissue is advantageous due to a rich vascular supply and proximity to the defect, while interposition grafts act as a scaffold for the migration of respiratory mucosa. The method described herein combines these principles to provide a suitable technique for the closure of nasal septal perforations.