Alternative

The greater palatine artery flap

A mucosal flap fed by the greater palatine artery, which arrives through the nasal floor. It is designed for perforations at the front, small or medium, when cartilage or bone remains around the hole.

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

Key landmark

≥ 0.5 cm

between the hole and the incisive canal: the minimum distance required.

Mariño-Sánchez et al., ch. 12, Springer 2026.

In brief

For holes at the front, small or medium, with remaining framework.

In its "racquet" version, it takes only septal mucosa for most holes.

Silicone sheets for at least 4 weeks; bare areas re-cover in about 6 weeks.

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

The principle

The surgeon cuts a mucosal flap that stays attached to its artery, the greater palatine, then rotates it to cover the hole. Because it keeps its own blood supply, it heals well.

In the so-called "racquet" version, used for most small and medium holes, only septal mucosa is taken. The bare areas re-cover with mucosa in about 6 weeks.

It is compatible with open rhinoplasty in the same operation.

Source: Mariño-Sánchez, Arana-Fernández, Santamaría-Gadea, ch. 12, in Alobid (ed.), Septal Perforation Repair, Springer 2026.

Who it is for, and who it is not for

Indicated

Perforation at the front, small or medium.
Hole at least 0.5 cm from the incisive canal, preferably in front of it.
Cartilage or bone remaining around the hole.

Contraindicated or poorly suited

Hole reaching the floor at the level of the incisive canal, or behind it.
No framework left around the hole.

After surgery

1Silicone sheetsAt least 4 weeks.
2Donor areasThey re-cover with mucosa in about 6 weeks.

Published results

The chapter gives no series of its own for this flap. Combined with inverted edges ("Racket-on-Donut"), one published series reports 13 patients out of 13 closed: see the combined flaps page.

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

Is my hole at least 0.5 cm from the incisive canal?
Is there cartilage or bone left around it?
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 does the incisive canal matter?

The greater palatine artery arrives through this canal. If the hole reaches it or lies behind it, the flap cannot cover it properly.

Can it be done during a rhinoplasty?

Yes, it is compatible with an open rhinoplasty.

Sources

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

2026Greater Palatine Artery Pedicled FlapMariño-Sánchez, Arana-Fernández, Santamaría-Gadea · ch. 12, in Alobid I. (ed.), Septal Perforation Repair: State-of-the-Art, Springer Nature