Septal perforation repair techniques

Advancement flaps, bridge flap, pedicled flaps, fascia lata, TPF-PDS, perfoplasty: ten techniques, seven of which actually close the hole. Every closure rebuilds the three layers of the septum; they differ in how they bring in the supporting tissue and the mucosa that covers it. Two words to know: a graft is tissue cut from its blood supply and transplanted; a flap is tissue moved while staying connected.

Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 2 November 2026 · Method and sources

On this page The three principles Seven closure techniques Without closing Experimental Everything side by side Approach, splints, empty nose

The three principles

silicone prosthesis mucosa cartilage perforation

Plug it

A septal button places a silicone disc on each side of the hole and passes through it. Nothing is repaired: it is a prosthesis, and a foreign body that can enlarge the perforation.

mucosa moved interposition graft perforation

Advance the mucosa

Neighbouring mucosa is lifted and slid across to cover the hole on both faces. This is the commonest approach; it spends mucosa from inside the nose.

resorbable plate and fascia mucosa left free perforation

Interpose a support

A support tissue (fascia, cartilage, resorbable plate) is slid between the two mucosal layers, which heal over it. This approach takes almost nothing from inside the nose.

Seven techniques that close the hole

Each technique has its own detailed page: the operation, the sizes it targets, the published series with their follow-up, the risks and the questions to ask.

Reading the labels What each technique takes from inside your nose Nothing, or almost Septal or nasal-floor mucosa Turbinates or inferior meatus, avoid if empty nose

The international standard Takes mucosa

Bilateral advancement flaps with interposition graft bilateral mucosal advancement flaps + interposition graft The mucosa is lifted on both faces, slid across like two curtains, and a support is interposed between the layers. Best published rate : 94.8% in 392 patients (Mayo Clinic); 95% in 154 patients in the UK; 86% in 81 endonasal repairs Read the full page ›

The German school Takes turbinates or floor

Bipedicled bridge flap bipedicled bridge flap, Brückenlappen (Schultz-Coulon) Strips of mucosa attached at both ends slide across the hole, with cartilage interposed. Designed for very large perforations. Best published rate : 72% durable closure at 67 months (Ulm series, the only long follow-up published); 93.8% short-term in 92 patients Read the full page ›

Pedicled flaps Takes mucosa

Anterior ethmoidal artery flap anterior ethmoidal artery (AEA) flap, extended AEA, Dragonfly flap A flap raised high on the septum, fed by its own artery, is swung down onto the hole. Robust, because it is genuinely vascularised. Best published rate : 11 of 11 closed at 51 months in the original series; 83% unilateral versus 92.3% bilateral Read the full page ›

Pedicled flaps Takes turbinates or floor

Floor, turbinate and lateral wall flaps nasal floor and inferior meatus (NFIM) flap, turbinate flaps, lateral nasal wall flap Mucosa comes from the nasal floor, a turbinate or the lateral wall and pivots onto the perforation. It does not grow back. Best published rate : Complete closure in all 5 patients and 10 cadaver specimens of the reference series; clinical series are still short Read the full page ›

The scaffold Takes nothing from the nose

Temporoparietal fascia and PDS plate temporoparietal fascia (TPF) + polydioxanone (PDS) plate interposition A resorbable plate wrapped in fascia is slid between the two mucosal layers, without suturing them. The mucosa grows back over it. Best published rate : 90% in two independent series; 62 patients across 7 institutions with improved NOSE scores Read the full page ›

The scaffold Takes nothing from the nose

Fascia lata and costal cartilage fascia lata graft, fascia lata-costal cartilage sandwich, Tricellufuse The thigh fascia fills what the mucosal flaps cannot reach, sometimes reinforced with rib cartilage. Best published rate : 92% in 25 patients all above 2 cm at 12 months; 86.3% at 12 months with Tricellufuse; 30/30 closed at 6 months in 2026 Read the full page ›

Salvage Takes nothing from the nose

Pericranial flap and salvage options pericranial flap, “money box approach”, paramedian forehead flap, free flap A vascularised membrane harvested from the skull, brought down through a frontal window, lines a destroyed septum. Best published rate : 91.2% closure in total perforations Read the full page ›

Two options that do not close the hole

The septal button plugs the hole with a prosthesis; perfoplasty smooths its edges to remove crusting and turbulence. Neither repairs the septum: the 2026 consensus reserves the button for patients who cannot or do not want surgery, and perfoplasty is discussed for posterior perforations or those judged unclosable.

Obturation Septal button septal button, septal obturator, septal prosthesis Takes nothing from the nose

A prosthesis that plugs the hole without repairing anything. Reversible, fitted without surgery, but a lifelong foreign body. Best published rate : 50.6% of wearers needed no further procedure at 5 years; 14 of 41 still wore their button after 1 to 9 years Read the full page ›

Not closing Perfoplasty and posterior enlargement septal perfoplasty, posterior enlargement, posterior septal resection Takes nothing from the nose

No closure: the edges are smoothed and, sometimes, the hole is moved back to where air no longer creates turbulence. Best published rate : Acceptable symptom control in 18 of 20 patients (90%), improvement in a median of 66 days Read the full page ›

Still experimental

Cartilage grown from your own cells, PRP, 3D printing: avenues in clinical trials, not yet treatments.

Experimental Regenerative techniques tissue-engineered cartilage (N-TEC), PRP, 3D-printed scaffolds, stem cells Takes nothing from the nose

A cartilage graft grown from your own cells, or regenerative adjuncts. Promising, but still at trial stage. Best published rate : Feasibility shown in 5 patients (phase I trial); no comparative efficacy established Read the full page ›

Everything side by side

Technique	Harvest	Sizes targeted	Best published rate	Reversible
Close the hole
Bilateral advancement flaps with interposition graft	Septal and nasal floor mucosa	Up to 2 cm, and beyond in expert centres	94.8% in 392 patients (Mayo Clinic); 95% in 154 patients in the UK; 86% in 81 endonasal repairs	No
Bipedicled bridge flap	Mobilises all the septal mucosa, from roof to inferior meatus	Large and subtotal, beyond 2 × 3 cm	72% durable closure at 67 months (Ulm series, the only long follow-up published); 93.8% short-term in 92 patients	No
Anterior ethmoidal artery flap	Mucosa from the upper septum	Anterior perforations, small to large (bilateral beyond 2 cm)	11 of 11 closed at 51 months in the original series; 83% unilateral versus 92.3% bilateral	No
Floor, turbinate and lateral wall flaps	The floor, the inferior meatus, sometimes a turbinate	Small and medium, lower third or lower three quarters of the septum	Complete closure in all 5 patients and 10 cadaver specimens of the reference series; clinical series are still short	No
Temporoparietal fascia and PDS plate	Nothing from inside the nose (temple harvest)	Medium; up to 4.5 cm in a recent series	90% in two independent series; 62 patients across 7 institutions with improved NOSE scores	No
Fascia lata and costal cartilage	Nothing from inside the nose (thigh, sometimes rib)	Large, beyond 2 cm	92% in 25 patients all above 2 cm at 12 months; 86.3% at 12 months with Tricellufuse; 30/30 closed at 6 months in 2026	No
Pericranial flap and salvage options	Nothing from inside the nose (skull harvest)	Total and subtotal, repeated failures	91.2% closure in total perforations	No
Without closing the hole
Septal button	Nothing from inside the nose	Any size, if a complete rim of tissue surrounds the hole	50.6% of wearers needed no further procedure at 5 years; 14 of 41 still wore their button after 1 to 9 years	Yes, completely
Perfoplasty and posterior enlargement	Almost nothing	Any, especially posterior or judged unclosable	Acceptable symptom control in 18 of 20 patients (90%), improvement in a median of 66 days	Partly
Experimental
Regenerative techniques	A few septal cartilage cells	0.5 to 2 cm in the phase I trial	Feasibility shown in 5 patients (phase I trial); no comparative efficacy established	No

These rates come from different series, with different definitions of success and different follow-up: read them as orders of magnitude, not as a ranking.

Open or endonasal? The meta-analysis of 64 studies (1,591 patients) finds no difference in closure rates. The choice depends on the surgeon and your anatomy, not on any proven superiority.

After the operation. Silicone splints left in for 2 weeks to 2 months depending on the team (longer if you pick your nose), rinses several times a day, no flying for 1 to 2 weeks. The result is only judged when the splints come out, then at 6 and 12 months.

Empty nose as well? If your turbinates have already been reduced, have that history noted in your file and ask the surgeon which technique they propose in this context: those that harvest from the turbinates or the inferior meatus could worsen one condition to repair the other.

From the 2026 Springer textbook

Seven more techniques

Not sure which one applies to you? The 4-question guide points you in the right direction.

Greater palatine flapHoles at the front, small or medium Combined flapsBoth sides covered, one side operated Inverted edges (Donut)The surrounding mucosa, turned over L-strut flapVery small holes, 5 mm or less Gingivobuccal flapHoles just behind the columella Posterior septal advancementLarge perforations without framework Bilateral nasoseptal flapsLarge perforations, above 2 cm

Keep reading

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