title: Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps.
abstract: Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.
  
  
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authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Islas Baleares, Spain. e_morera@hotmail.com.
authors.forename: Eduardo
authors.identifier: http://orcid.org/0000-0003-4601-6027
authors.initials: E
authors.lastname: Morera Serna
authors.affiliation: Servicio de Otorrinolaringología, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ferrán de la Cierva
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Islas Baleares, Spain.
authors.forename: Meritxell Tomás
authors.initials: MT
authors.lastname: Fernández
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Islas Baleares, Spain.
authors.forename: Santiago Quer
authors.initials: SQ
authors.lastname: Canut
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Islas Baleares, Spain.
authors.forename: Jacoba Alba
authors.initials: JA
authors.lastname: Mesquida
authors.affiliation: Servicio de Otorrinolaringología, Hospital General Universitario los Arcos del Mar Menor, Pozo Aledo, Murcia, Spain.
authors.forename: Francisco José García
authors.initials: FJG
authors.lastname: Purriños
mesh_terms: D000328:Adult; D004844:Epistaxis / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061270:Nasal Septal Perforation / Q000175:diagnosis / Q000601:surgery; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000601:surgery; D059747:Nasal Surgical Procedures / Q000009:adverse effects / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D013030:Spain; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Haddad flap; Large septal perforation; Schneiderian mucosa