"Pedicled Flaps for Nasal Septal Perforation and Graft Framework: Enhancing Outcomes in Preservation and Structural Rhinoplasty"

Mariño-Sanchez F, Alobid I, Santamaría-Gadea A.

PubMed 41071182 Publisher (DOI)

What this paper says

Two case reports show that a septal perforation can be closed with blood-supplied lining flaps and the nose reshaped, including with dorsal preservation, in the same operation.

Overview

Septal perforation repair has advanced with flaps based on the anterior ethmoidal and greater palatine arteries. Combining repair with rhinoplasty has been avoided because grafts depend on the lining for blood supply and exposing the L-strut risks absorption or infection. The Spanish authors describe modified "racket-on-donut" and "boot-on-donut" flap techniques that cover grafts on both sides with mucosa and rebuild the dorsal L-strut under a preserved dorsum, illustrated by two patients.

Sections of note

Case 1: a 62-year-old with an anterior perforation and structural deformity; the modified racket-on-donut flap covered the perforation and a septal replacement graft on both sides.
Case 2: a 65-year-old with a larger perforation and thin skin; the modified boot-on-donut flap repaired it while dorsal preservation kept the keystone intact.
Both cases used an open approach for access and flap mobilisation.
The authors state preservation rhinoplasty was "traditionally contraindicated" in perforation repair and proved effective here.

What it means for a patient

A hole in the septum and an unsatisfactory nasal shape can, in expert hands, be addressed in one operation.
The evidence is two patients; it shows feasibility, not a track record.
These are complex operations available at few centres.

Why this paper matters

It extends perforation-repair flaps into combined reconstructive and preservation rhinoplasty. Limits: two cases, no follow-up duration stated, no outcome measures.

Terms

Septal perforation: a hole through the septum, causing crusting, whistling and bleeding.
Pedicled flap: tissue moved while still attached to its blood supply.
Anterior ethmoidal artery / greater palatine artery: vessels that supply the nasal lining flaps used for repair.
L-strut: the L-shaped rim of septum that must remain to support the nose.
Keystone area: the central junction of nasal bones and cartilages on the bridge.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Nasal septal perforation (NSP) repair has evolved with the development of advanced techniques like the anterior ethmoidal artery (AEA) and greater palatine artery (GPA) flaps, achieving high success rates. Traditional challenges in combining NSP repair with rhinoplasty stem from the reliance on mucoperichondrial blood…”

Excerpt; the full abstract is on PubMed.