Superior Labial Artery Flap for Septal Perforation Repair: The Boxer's Flap

Anterior nasal septal perforations (NSPs) can cause significant morbidity and are often challenging to repair in revision settings where posterior septal mucosa lack integrity, are difficult to raise, or are traumatized. We describe an anteriorly pedicled nasal floor mucoperiosteal flap based on the superior labial artery (SLA) and report anatomical and symptomatic outcomes in patients where traditional anterior ethmoid and greater palatine artery flaps are not readily available.

A case series of consecutive adult patients undergoing endoscopic NSP repair using an SLA-based anterior pedicled floor flap was performed. Outcomes included anatomical closure, Miglani endoscopic score, symptom evaluation with SNOT-22 and nasal subdomain scores. The definition of outcome was defined by both resolution of clinical symptoms and anatomical closure, with "complete" being both.

Twenty-one patients (age 41.5 ± 10.9 years; 57.1% female) were followed for 9.4 ± 3.6 months. Most perforations were anterior (85.7%) and iatrogenic (surgical trauma) in etiology, with a mean area of 92.6 ± 71.9 mm². Anatomical closure was achieved in 90.5 [71.1-97.3]% of cases, with partial closure in 9.5 [2.7-28.9]%. Endoscopy assessment improved (Miglani 3.14 ± 1.56 v 0.62 ± 0.86; p < 0.001). Symptoms improved in both nasal subdomain (14.1 ± 6.2 v 3.5 ± 3.2, p < 0.001) and SNOT-22 (38.6 ± 21.8 v 9.8 ± 11.5, p < 0.001). Complete success (anatomical closure with symptom resolution) was achieved in 90.5 [71.1-97.3]%.

The SLA-based nasal floor flap provides high closure rates and symptomatic improvement in NSP cases where traditional septal flaps are not feasible.