Free Mucosal Grafting Is a Simple Adjunct for Rapid Re-Epithelization in Septal Perforation Repair

Mucosal grafting has become more established in rhinology. While it is accepted that free mucosal grafts take to bone and vascularized recipient beds, the use of mucosal grafting on the contralateral side during nasal septal perforation (NSP) repair with vascularized flaps is not well recognized, but is an important adjunct to ensure healthy reepithelialization of the contralateral septum.

Consecutive patients undergoing endoscopic NSP repair with a contralateral free mucosal graft between 2014 and 2025 were included. Grafts were placed opposite the flap on a collagen matrix interlay. The primary outcome was the integration of the free graft judged as complete, partial, or failed. Secondary outcomes included the overall anatomical closure, Miglani endoscopic score, and nasal symptoms assessed via the SNOT-22 nasal subdomain.

Ninety patients (age 44.3 ± 15.5 years; 56.7% male) were followed up for a median of 4.0 [2.0-7.0] months. Most repairs utilized an anterior ethmoidal artery flap (95.6%). Free graft integration was complete in 85.6% of all cases (6.7% partial). Anatomical closure was achieved in 90.0% and free graft integration was complete in 92.6% of those patients. Preoperative vs. postoperative endoscopic assessment (3.0 [2.0-5.0] vs. 0.0 [0.0-1.0], p < 0.001) and nasal subdomain scores improved significantly (9.0 [6.0-14.0] vs. 4.0 [2.0-10.0], p < 0.001).

Contralateral free mucosal grafts heal reliably in endoscopic NSP repair, with complete healing in over 93% of patients with successful closure. The technique is simple to perform and assists in achieving rapid reepithelialization in an area at high risk of desiccation and poor healing.