SURGICAL REPAIR OF NASAL SEPTAL PERFORATI ON WITH THE BIPEDICLED-FLAPTECHNIQUE IN 126 CASES - AN ANALYSIS

Background: The surgical closure of a nasal septal perforation is cons idered to be one of the most difficult procedures in nasal surgery wit h a relatively poor success rate. After a new surgical concept (''bipe dicled-flap technique'') was developed, a followup study was done in o rder to find out whether surgical results can be improved by means of this new method. Patients and Method: From 1988-1995 the bipedicled-fl ap technique was applied in 126 patients with nasal septal perforation s (82 males, 44 females). in all patients the closure of the septal pe rforation was performed with an endonasal bilateral bipedicled-flap pl asty and reconstruction of the cartilaginous defect with an autogenous cartilage graft from either the rib, the auricle, or from remnants of the septal cartilage. Postoperative results were evaluated in all pat ients. The follow-up period varied from a minimum of six months to a m aximum of over seven years. Results: The age peak was found in the thi rd decade of life (females) and fifth decade (males), respectively. Mo st frequent preoperative symptoms were difficult nasal breathing, crus ting and recurrent epistaxis. 65.8% of septal perforations were of iat rogenic origin. In 32 patients, the aetiology remained unknown. Six pa tients used silicone obturators preoperatively without getting any rel ief from complaints. In nine patients, surgical repair of the septal p erforation had been attempted previously at another hospital. With the bipedicled-flap technique, primary closure was achieved in 118 patien ts (=93.6%); revision surgery (same technique) was successfully perfor med in 2 patients, increasing the final success rate to 95.2%. Complic ations were rare and could always be managed easily. Conclusions: At p resent, the bipedicled-flap technique appears to be the most successfu l method for surgical repair of nasal septal perforations. The underly ing principles responsible for the good success rate are: (1) the bila teral closure of the mucosal defects; and (2) the additional reconstru ction of the cartilaginous septal defect with an autogenous cartilage graft only.