Very small holes

The L-strut flap

A flap cut from the L-shaped framework of the septum, for very small holes at the front, when surgery has already removed the cartilage around them.

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

Target size

≤ 5 mm

very small holes, at the front, after surgery.

Rusetsky et al., ch. 17, Springer 2026.

In brief

For holes of 5 mm or less.

Located at the front, after septal surgery.

When no cartilage is left around the hole.

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

The principle

After a septoplasty, an L-shaped strip of cartilage usually remains to support the nose. The flap is cut from the mucosa of this area to cover a very small neighbouring hole.

Source: Rusetsky, Mokoyan, Elumeeva, ch. 17, in Alobid (ed.), Septal Perforation Repair, Springer 2026.

Who it is for, and who it is not for

Indicated

Hole of 5 mm or less.
At the front, after surgery.
No cartilage left around the hole.

Contraindicated or poorly suited

Larger holes: other techniques apply (see the guide).

Published results

A technique described by a single team; the chapter offers no series comparable with other techniques.

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

Does my hole really measure 5 mm or less?
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 only very small holes?

The mucosa available in this area is limited: it is enough only for very small perforations.

Sources

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

2026L-Strut FlapRusetsky, Mokoyan, Elumeeva · ch. 17, in Alobid I. (ed.), Septal Perforation Repair: State-of-the-Art, Springer Nature