title: Endonasal septal perforation repair using posterior and inferiorly based mucosal rotation flaps.
abstract: OBJECTIVE
  Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.
  
  
  OBJECTIVE
  To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series.
  
  
  METHODS
  The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015.
  
  
  METHODS
  The study took place at MetroHealth Medical Center in Cleveland, Ohio.
  
  
  METHODS
  Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10-67years). INTERVENTION FOR CLINICAL TRIALS OR EXPOSURE FOR OBSERVATIONAL STUDIES: Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap.
  
  
  METHODS
  The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery.
  
  
  RESULTS
  Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (<1cm) had a 93.3% success rate, medium (1-2cm) 88.9%, and all seven large perforations (>2cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure.
  
  
  CONCLUSIONS
  Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum.
authors.affiliation: Department of Biology, Case Western Reserve University, Cleveland, OH, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Dayton
authors.affiliation: Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States.
authors.forename: Nipun
authors.initials: N
authors.lastname: Chhabra
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University, Cleveland, OH, United States; Department of Otolaryngology - Head and Neck Surgery, MetroHealth Medical Center, Cleveland, OH, United States. Electronic address: shouser@metrohealth.org.
authors.forename: Steven
authors.initials: S
authors.lastname: Houser
mesh_terms: D062088:Acellular Dermis; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061270:Nasal Septal Perforation / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Acellular dermis; Interposition graft; Rotation flap; Septal perforation; Septoplasty