Both sides covered

Combined flaps: Racket-on-Donut and Boot-on-Donut

A pedicled flap, taken from one side only, is combined with the inverted edges of the hole. Result: the hole is covered on both sides while only one side of the nose is operated on.

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

Published series

31 / 31

perforations closed in the team's two series (13 + 18 patients).

Rodriguez-Van Strahlen et al., ch. 19; Calvo-Henriquez et al., ch. 25, Springer 2026.

In brief

Anterior hole under 2 cm: greater palatine plus inverted edges ("Racket-on-Donut").

Larger anterior hole: extended AEA plus inverted edges ("Boot-on-Donut").

Remaining framework around the hole is required.

On this page Principle Who for After Results Questions for the surgeon Questions Sources

The principle

The mucosa around the hole is turned over to the other side to close the opposite face: these are the inverted edges, or "donut". On the operated side, a pedicled flap covers the whole area.

Two combinations are described according to the size of the anterior hole.

1Racket-on-DonutAnterior hole under 2 cm: greater palatine flap plus inverted edges.
2Boot-on-DonutLarger anterior hole: extended anterior ethmoidal artery flap plus inverted edges.

Source: Rodriguez-Van Strahlen, Castro, Alobid, ch. 19, in Alobid (ed.), Septal Perforation Repair, Springer 2026.

Who it is for, and who it is not for

Indicated

Perforation at the front.
Remaining framework around the hole.

Contraindicated or poorly suited

Boot-on-Donut: not indicated if a lot of septal cartilage has been removed.
Poorly healed or ulcerated hole edges (contraindication to inverted edges).

After surgery

1Rinses and ointmentGenerous rinses 2 to 3 times a day, then ointment until fully healed, and long term afterwards.
2Silicone sheets3 to 4 weeks, longer in case of nose picking (6 weeks in the case presented).
3CrustsRemoved by the surgeon, with a check every 1 to 2 weeks in the first month.

Published results

13 / 13

Racket-on-Donut

Published series, 100% closure

18 / 18

Boot-on-Donut

Published series, 100% closure

These are small series, published by the team that described the technique.

Published series come from very experienced teams: they are ceilings, not promises. [[success-rates|The real success rates ›]]

Note before the consultation

Questions to ask the surgeon

Are my edges healthy enough to be inverted?
How much cartilage is left on my septum?
How many times a year do you perform this technique, and with what closure rate at 1 year? (All the questions: the guide.)

Frequently asked questions

Why operate on one side only?

The inverted edges close the opposite face: this avoids taking mucosa from both sides of the nose.

How long do the sheets stay in?

3 to 4 weeks according to the chapter, longer in patients who pick their nose.

Sources

Every figure on this page comes from one of these publications. The year is the year of publication.

2026Combined FlapsRodriguez-Van Strahlen, Castro, Alobid · ch. 19, in Alobid I. (ed.), Septal Perforation Repair: State-of-the-Art, Springer Nature
2026A Systematic Review with Meta-Analysis Assessing Perforation Closure Rate and Predictors of Successful ClosureCalvo-Henriquez C., Sanchez-Gomez S., Alobid I. · ch. 25