Abstract
The objective of this study is to assess the results of repairing septal perforations with a vascularized pedicled alar cartilage island flap. Using the external rhinoplasty approach, a vascularized flap of alar cartilage, harvested as a cephalic trim and pedicled on the ascending columellar branches of the superior labial artery was raised. Bilateral mucoperichondrial septal flaps were elevated and the alar flap was transposed and secured within the defect and bilaterally overlaid with temporalis fascia. Silastic sheets were placed and remained in situ until the grafts were revascularized from the peripheries of the defect as well as centrally from the alar flap. The revascularized temporalis fascia acted as a scaffold for nasal remucosalization. The alar flap also increased the long-term structural robustness of the repair. Between 1999 and 2003, 14 patients with septal perforations ranging from 10 to 31 mm underwent septal reconstruction using this technique. There were nine males and five females. The flap was successfully raised in all cases and long-term closure was maintained in 12 patients (86%). The alar cartilage flap is an effective technique for repairing septal perforations in selected patients. It provides vascularized tissue which nourishes the grafts during remucosalization, and a cartilaginous framework, which affords long-term structural support to the repair. It also obviates the need to transpose nasal mucosa and create a secondary defect. The rhinoplasty approach furthermore permits additional nasal deformities to be corrected at the same time.
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References
Dommerby H, Rasmussen OR, Rosborg J (1985) Long-term results of septoplastic operations. ORL 47:151–157
Belmont JR (1985) An approach to large nasoseptal perforations and attendant deformity. Arch Otolaryngol 111:450–455
Willkens RF, Roth GJ, Novak A, Walike JW (1976) Perforation of nasal septum in rheumatic diseases. Arthritis Rheum 19:119–121
Seyer BA, Grist W, Muller S (2002) Aggressive destructive midfacial lesion from cocaine abuse. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 94:460–465
Brain DJ (1980) Septo-rhinoplasty: the closure of septal perforations. J Laryngol Otol 94:495–505
Romo T, Jablonski RD, Shapiro AL, McCormich SA (1995) Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations. Arch Otolaryngol Head Neck Surg 121:327–331
Paloma V, Samper A, Cervera-Paz FJ (2000) Surgical technique for reconstruction of the nasal septum: the pericranial flap. Head Neck 22:90–94
Murrell GL, Karakla DW, Messa A (1998) Free flap repair of septal perforation. Plast Reconstr Surg 102:818–821
Kridel RW, Foda H, Lunde KC (1998) Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 124:73–78
Romo T, Sclafani AP, Falk AN, Toffel PH (1999) A graduated approach to the repair of nasal septal perforations. Plast Reconstr Surg 103:66–75
Woolford TJ, Jones NS (2001) Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft. J Laryngol Otol 115:22–25
Shaw CK, Cowin A, Wormald PJ (2001) A study of the normal temporal healing pattern and the mucociliary transport after endoscopic partial and full-thickness removal of nasal mucosa in sheep. Immunol Cell Biol 79:145–148
Ohashi Y, Nakai Y, Ikeoka H, Furuya H (1991) Regeneration of nasal mucosa following mechanical injury. Acta Otolaryngol Suppl 486:193–201
Hardillo J, Vanclooster C, Delaere PR (2001) An investigation of airway wound healing using a novel in vivo model. Laryngoscope 111:1174–1182
Niranjan NS (1988) An anatomical study of the facial artery. Ann Plast Surg 21:122–144
Rohrich RJ, Gunter JP, Friedman RM (1995) Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 95:795–799
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Nouraei, S.A.R., Singh, C.B., Ferguson, M.S. et al. The remucosalizing alar cartilage flap: a reconstructive option for repairing nasal septal perforations. Eur J Plast Surg 30, 153–157 (2007). https://doi.org/10.1007/s00238-007-0159-1
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DOI: https://doi.org/10.1007/s00238-007-0159-1