First the mucosa on both sides of the septal defect is undermined from the front through a transfixion incision, and the defect is freshened. The entire mucosa
Fig. 5.59 Bilateral bipedicled flap technique of Schultz-Coulon (1989).
a The septal mucosa around the defect is mobilized through a hemitransfixion incision, and the entire mucosa is mobilized past the nasal floor to the inferior turbinate (here on the right side). The mucosa on the left side is separated past the nasal dorsum. The mucosa on the right side is incised below the turbinate and mobilized, and the mucosa on the left side is incised dorsally and mobilized. (These flaps can also be incised superiorly or inferiorly on both sides.) b Bilateral coverage of the septal defect. c Closure viewed from the right side.
on one side is then mobilized down to the nasal floor and inferior turbinate, divided (Fig. 5.59a, right), and advanced toward the defect (Fig. 5.59b, right). On the opposite side, the mucosa above the defect is mobilized past the sidewall and dorsum and divided (Fig. 5.59a, left). The mucosal flap is then pulled down over the defect like a roller shade, and the defects are closed (Fig. 5.59c). This can also be done with mucosa that is mobilized only superiorly or only inferi-orly.
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