Endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap

Objective To introduce the method and evaluate the efficacy of endoscopic repair of nasal septal perforation with aeellular dermal matrix and pedicled mucoperichondrial flap. Methods Twelve patients with perforation of nasal septum were encountered since February 2006 to October 2010. The most common symptoms and sings were nasal obstruction and crusting at the margin of the perforation. Eight of 12 patients were iatrogenic following surgery. The perforation typically located at anterior medial part of the nasal septum, with their sizes ranged approximately 1.0 - 2.3 cm in diameter. The incision was made at the anterior edge of the perforation from the left nasal cavity and continued to the nasal floor horizontally. It ended at the lateral nasal cavity. Then, another incision was made parallel to the first one, which was 1.5 cm from the posterior of the perforation. The two incisions was connected. The mucoperiehondrium was stripped along with the incisions and the pedicle of mucoperichondrial flap kept on the nasal septum. Then, the flap was turned up to cover the perforation and fixed with apposition suture. Put the acellular dermal matrix graft on the perforation from the fight nasal cavity and fixed it with apposition suture. Results The healing of the acellular dermal matrix and mueoperichondrium was good in the first week postoperatively and there was no rejeetive reaction and contracture. The epithelization of the nasal septal perforation finished 4 weeks after surgery. Follow-up ranged from 3 months to 4 years. Eleven patients had successful outcomes with complete closure of their perforations. One patient failed the operation. All of them had no complications. Conclusions Using acellular dermal matrix graft and mucoperiehondrial flap to repair the septal perforation is a simple method and the success rate is high. Therefore, it is an effective way to repair the perforation of nasal septum. Key words: Nasal septum; Endoscopy; Reconstructive surgical procedures; Surgical flaps; Dermis; Transplantation