Use of Butterfly Composite Conchal Cartilage Graft with Local Posteriorly Pedicled Flap in Repair of Nasal Septum Perforations

Background : Nasal septal surgery is the most frequent cause of nasal septal perforations (NSP). Sometimes when symptomatic they need repair. There are many methods described for repair with a variable percent of success. The multiplicity of techniques and approaches reflect the difficulty of repair. Objective: To describe a new effective method to repair NSP using a butterfly composite conchal cartilage graft (BCG) with local posteriorly pedicled flap in repair of NSP. Patients and Methods: Eleven patients with NSP after nasal septum surgery were involved in this study. In all of them an ample flap, right sided, pedicled posteriorly on sphenopalatine artery was fashioned. It was rotated to cover the perforation on the right side. A composite skin choncal cartilage graft equal to NSP diameter is dissected. The cartilage graft was fashioned by splitting its edge circumferentially with a depth of 2-3 mm and was positioned with the skin island lying on the left side and the fissured graft edge embracing the perforation cartilaginous border inside its fissure. The graft and the flap were fixed in place with quilting and mattress sutures and silastic sheets on both sides. Mucosal flap was used alone in three cases with small perforations. Results: Complete closure of NSP was achieved in 10 cases (91%). Only one case the graft was rejected with partial closure of the perforation due to bad fixation and secondary infection. Conclusion: BCG was an excellent graft to repair NSP if associated with posteriorly pedicled mucosal flap supplied by the sphenopalatine artery.