Experiences with the bridge-flap technique for the repair of large nasal septal perforations

After a review of the literature a modified surgical method called "bilateral bridge-flap technique" for the closure of nasoseptal perforations is outlined. After an extensive elevation of mucoperichondrium and mucoperiosteum from the entire septum as well as from the nasal roof and the nasal floor bipedicle advancement flaps are created: on one side above the perforation by a longitudinal incision along the nasal roof, and on the opposite side below the perforation by a longitudinal incision along the lateral wall of the lower nasal meatus. In very large perforations it may be necessary to create two bridge flaps on each side, one below and the other one above the perforation. After bilateral closure of the mucosal defects the cartilaginous defect is entirely filled with an autogenous cartilage graft taken either from remainders of the septum or from the auricle or rib. Until now this method has been applied in 54 patients with nasoseptal perforations measuring between 0.3 x 0.5 cm and 2 x 5 cm. Forty-eight patients had a follow-up of more than six months; in 45 (93.75%) of these cases the procedure was successful. In the other six patients closure of the perforation could also be obtained, but they were excluded from the evaluation of the overall success rate because of their short follow-up. The essential characteristics illustrating this technique's reliability are: (1) the principally bilateral closure of the mucosal defects; and (2) the additional reconstruction of the cartilaginous septal defect with an autogenous cartilage graft only.