Small Perforations

Small septal perforations can be managed with small unilateral or bilateral U-advancement flaps, which can be elevated in one or two layers (Fig. 5.54). Small unilateral or bilateral rotation flaps (Fig. 5.55) and bipedicled flaps (Fig. 5.56) may also be considered. We have also used anteriorly or posteriorly based mucosal flaps from the inferior nasal turbinate, in which case a small piece of turbinate bone may be transferred with the flap (Fig. 5.57a). A second operation is needed for dividing the flap and insetting it into the anterior or posterior wound margin in the septum.

Fig.5.54a,b U-advancement flap
Rotation Advancement Flap Axilla

Fig. 5.55a,b A rotation flap may be incised anterior or posterior to the defect.

Fig. 5.55a,b A rotation flap may be incised anterior or posterior to the defect.

Fig. 5.56a, b Bipedicled flap

Fig. 5.57a Posteriorly (or anteriorly) based flap from the inferior turbinate (may include a piece of bone).

b Meyer's intraoral mucosal flap. The flap is precut and prelined with a cartilage graft. Two weeks later it is delivered through a tunnel to the nasal septum. The wound is closed in two layers, and the flap is detached at 3 weeks.

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