A Different Approach to the Reconstruction of Nasal Septum Perforations: Alar Winged Flap.

PURPOSE: Nasal septal perforations (NSPs) are one of the major complications among the nose surgery that the surgeon has to solve it. There are many reasons on the etiology of septal perforation such as iatrogenic and idiopathic. All the surgical procedures are based on 2 main principles, namely repair using an intranasal flaps: mucosal, mucoperichondrial, mucoperiosteal flaps within the nasal cavity; and extranasal flaps. Operation can be carried out using either the "closed technique" or "open technique." The author presents a different or additional method, namely alar winged flaps (AWFs).

PATIENTS AND METHODS: Between 2010 and 2014, a total of 13 patients with medium-large NSP were treated with this approach. Of these 13 patients, 9 were male (69%) and 4 female (31%). Average age was 40.13 years. In 13 cases, average diameter of the perforation was between 1.5 and 2.4 cm; in 1 case, it was >3 cm; in 2 cases, it was <2 cm.

RESULTS: Alar winged flaps was used for better exposure in all patients. Etiology of the NSP was detected as previous septal surgery in 5 cases (38%), over septal tissue resection in 3 cases (23%), and infection at septal surgery, blunt trauma, >1 blunt trauma, nasal corticosteroid using, respectively. There was no preoperative and postoperative complication. At the early follow-up, AWF flap incision scar was cosmetically satisfactory.

DISCUSSION: As can be seen from the senior authors' description, especially large NSPs are difficult problems to solve. The proposed surgical techniques are still offered the highest recurrence rates. To address this problem, the authors developed the AWF method. The operation time before using AWF was so long in our previous NSP surgeries. After AWF, the authors saved an average of 14 to 25 minutes in each operation. No visible scar is seen on the AWF donor areas at the early follow-up. The authors suggest this flap method bilaterally and/or unilaterally for the medium or large perforations.